Complementary Feeding Of Infants Research Articles

World Health Organization (WHO) guideline on the complementary feeding of infants and young children aged 6-23 months 2023: A multisociety response.

The recent World Health Organization(WHO) guideline aims to provide evidence-based recommendations on complementary feeding (CF) of healthy term infants and young children 6-23 months living in low-, middle-, and high-income countries, including both breastfed and non-breastfed children. Like WHO, our organizations aim to promote optimal infant and young child nutrition and health, with a focus on promoting breastfeeding as well as appropriate and timely CF. In this paper, we share our concerns about aspects of the guideline, some of which may have the potential to cause unintended harm in infants and young children and suggest alternative or modified proposals.

Complementary feeding in infants with cystic fibrosis: In vitro nutrient digestibility and impact on colonic microbiota

The aim was assessing macronutrient digestibility of common purees in the context of children with cystic fibrosis (CF) starting complementary feeding. A static in vitro digestion model was set up reproducing the conditions of infants with CF and healthy controls. Egg, chicken, infant formula and infant cereal were subjected to digestion individually and in combination with other ingredients. The resulting digesta was subjected to colonic fermentation with the faecal inoculum of an exclusively breast-fed infant with CF. Results showed overall low proteolysis and lipolysis, with positive interaction between egg and chicken with potato, vegetables, and olive oil. Contrarily, the combination of infant cereals and formula had a negative interaction. Notably, the dose of pancreatic enzymes had no effect on lipolysis. Purees rather than in individual foods impacted colonic microbiota, by reducing Bifidobacterium while increasing Veillonella. This study could guide future dietary recommendations for complementary feeding in infants with CF.

The Relationship between Maternal Factors and the Timely Initiation of Complementary Feeding for Infants, in West Sumatera Province, Indonesia

Objective − This study looked into the relationship between maternal factors and the timely initiation of complementary feeding for infants. Material and Methods − A cross-sectional study was conducted from September to December 2022 on 196 mothers and their children aged 6-23 months. This study collected data through a questionnaire that included sociodemographic informa- tion, the Infant and Young Child Feeding Questionnaire for Child Care Providers (IYCF-CCPQ), the Iowa Infant Feeding At- titude Scale (IIFAS), and the time of initiation of complementary feeding.Results − This study included 196 mothers, with 128 (55.1%) having adequate knowledge of complementary feeding and 112 mothers (59.7%) had a negative view of infant feeding. The rate of timely initiation of complementary feeding was 71.4%. The mothers’ knowledge of infant feeding did not predict the timely initiation of complementary feeding (OR=1.18; 95% CI=0.62-2.26). However, maternal attitudes toward infant feeding were linked to the timely initiation of complementary feeding (OR=2.14; 95% CI=1.14-4.02). Conclusions − Mothers with positive attitudes toward infant feeding were twice as likely to start complementary feeding on time as those with negative at- titudes. Counseling mothers on the importance of timely initiation of complementary feeding is therefore required to improve mothers’ attitudes toward providing complementary foods to their infants in accordance with health recommendations.

Co-ingestion of Cereals and Legumes during Infant Complementary Feeding: Starch and Protein in vitro Digestion.

This study explores the impact of co-ingesting cereals and legumes on starch and protein during simulated infant in vitro digestion. Various legumes (chickpeas, lentils, peas) were added to cereals (durum wheat, brown rice, white maize), and their effects on starch and protein hydrolysis were analyzed. Substituting 50% of cereal with legumes increased proteins, minerals, and dietary fiber. Infant food with legumes exhibited smoother pasting properties. Legumes in cereal purées led to varying starch hydrolysis trends, with the lowest values in durum wheat with chickpea and all cereal blends with peas. Resistant starch levels exceeding 50% were found in infant food samples. Digested protein hydrolysis increased with legumes in durum wheat, except for peas. Brown rice mixtures decreased significantly compared to the control with chickpeas (61%) and peas (42%), while lentil blends increased by 46%. Legumes generally did not significantly affect starch bioavailability, even with α-amylase inhibitors. Lentil-cereal purées could enhance infant food nutritional value.

Association Between Dietary Diversity and Caregiver Self-Efficacy for Complementary Feeding Among Infants and Young Children Aged 6-23 Months in Rural Nanchong City,Sichuan Province

Objective To analyze the current situation of dietary diversity and caregiver self-efficacy for complementary feeding among infants and young children aged 6 to 23 months in rural Nanchong city,Sichuan province,and to explore the relationship between dietary diversity and caregiver self-efficacy. Methods Multi-stage randomized cluster sampling method was used to select infants and young children aged 6 to 23 months and their caregivers in rural areas of Nanchong city,Sichuan province as the subjects.A structured questionnaire was designed to collect the basic information of the subjects,dietary diversity,and caregiver self-efficacy for complementary feeding.Multivariate Logistic regression was adopted to analyze the relationship between the dietary diversity and caregiver self-efficacy for complementary feeding of infants and young children. Results A total of 770 pairs of infants and young children and their caregivers were included.The minimum pass rate of dietary diversity was 61.56%(474/770) for all the infants and young children and 45.00%(108/240),69.16%(287/415),and 68.70%(79/115) for the infants and young children aged 6 to 11,12 to 17,and 18 to 23 months,respectively.The results of regression analysis showed that the caregiver self-efficacy of complementary feeding was a contributing factor for qualified dietary diversity of infants and young children in the case of other confounders being controlled(OR=1.42,95%CI=1.17-1.73,P<0.001). Conclusion The dietary diversity for infants and young children in rural Nanchong city,Sichuan province needs to be improved,and caregivers with higher self-efficacy of complementary feeding are more likely to provide diversified complementary feeding for infants and young children.

Risk Factors and Implications of Early Introduction of Complementary Feeding in Infants: A Case-Control Study in Peshawar, Pakistan

Risk Factors and Implications of Early Introduction of Complementary Feeding in Infants: A Case-Control Study in Peshawar, Pakistan

Complementary Feeding Practices: Recommendations of Pediatricians for Infants with and without Allergy Risk.

To investigate the routine guidance provided by pediatricians concerning the timing of complementary feeding (CF) for both healthy infants and those at a heightened risk of allergies. A total of 233 pediatricians participated in an anonymous online survey that included questions about demographics and recommendations for CF. Specifically, they provided guidance on the types of foods, preparation methods, supplements, time intervals for introducing new foods to infants at low and high allergy risk, and delayed food introductions for high-risk cases. The respondents advised introducing certain foods at specific ages: fruits, starchy non-gluten grains, vegetables, olive oil, and meat were appropriate at 6 months; gluten-rich grains at 7 months; yogurt, hard-boiled eggs, and legumes at 8 months; fish at 8.5 months; and nuts at 9 months. Pediatricians, especially those with less than 15 years of practice, often introduced egg, seafood, gluten-rich grains, legumes, and nuts earlier for high-risk infants. Parenthood and male gender were associated with the earlier introduction of eggs and grains. Greek pediatricians follow a structured food introduction schedule for CF in infants. Interestingly, they tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants. Key Notes: Despite recent evidence-based indications on healthy complementary feeding strategies for infants, discrepancies persist among pediatricians regarding food choices and the order and timing of food introduction, both for healthy infants and those at risk of allergy. Guidance on complementary feeding by pediatricians is influenced by their individual characteristics. Pediatricians tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants.

Complementary feeding in infants born preterm: Aspects needing improvement.

The aim of our study was to collect data on complementary feeding (CF) in preterm infants (PIs). We enrolled PI ≤ 34 weeks of gestational age discharged from the neonatal intensive care unit (NICU) of the University Hospital of Padova. At 12 months of corrected age (CA), CF was investigated with questionnaires to the parents and a 24-h dietary recall. In a subgroup of newborns, we also evaluated bone status at a CA of 12 months using quantitative ultrasound. We studied 167 ex PI at 1 year of CA. CF was introduced in 67.1% of them between 5 and 8 months of chronological age, with fruit as the first food (81%, n = 136). Sweet drinks were consumed by 17.4% of our sample, and salt was added in 33.5% of cases. PIs, at 1 year CA, introduced extra energy compared to the theoretical requirement (121 ± 31 kcal/kg/day) and higher protein intake than recommended (39 ± 11 g/day), while the intake of both total lipids and carbohydrates was slightly lower. Vitamins and minerals were adequate, except vitamin D. Regarding bone status, we found a correlation between vitamin D intakes from the diet and bone parameters (metacarpus-bone transmission time: r = 0.36, p = 0.01) at 1 year of CA. Our population of PIs started CF in agreement with current suggestions though with a notable heterogeneity and with some mistakes. Vitamin D intake was correlated with bone status at 1 year of CA.

A Study to Evaluate the Effectiveness of Self-Instructional Module on Knowledge and Practices Regarding Complementary Feeding of Infants From 6 Months to 12 Months among Mothers of Selected Rural Areas of Gulbarga

A Study to Evaluate the Effectiveness of Self-Instructional Module on Knowledge and Practices Regarding Complementary Feeding of Infants From 6 Months to 12 Months among Mothers of Selected Rural Areas of Gulbarga

Food pattern modeling to inform global guidance on complementary feeding of infants.

Nutrient needs are difficult to meet during infancy due to high nutrient requirements and the small quantities of food consumed. Guidelines to support food choice decisions are critical to promoting optimal infant health, growthand developmentand food pattern modeling can be used to inform guideline development. We employed the Optifood modeling system to determine if unfortified complementary foods could meet 13 nutrient targets for breastfed infants (6-11 months), and to describe food patterns that met, or came as close as possible to meeting targets. We also examined the impacts of eliminating food groups, increasing starchy staple foodsor adding sentinel unhealthy foods. We collated a global food list from dietary studies in 37 countries and used this list to develop nutrient values for a set of 35 food subgroups. We analyzed infant dietary intakes from studies in eight countries to inform maximum quantities and frequencies of consumption for these subgroups in weekly food patterns. We found that unfortified foods could meet targets for most infants for 12 nutrients, but not for iron. For the smallest and youngest infants, with the lowest energy intakes, there were additional deficits for minerals. Best-case food patterns that met targets or came as close as possible to meeting targets included ample amounts of diverse vegetables, diverse plant- and animal-source protein foods, small amounts of whole grain foods and dairyand no refined grains or added fats or sugar. There were nutrient deficits if animal-source foods or vegetables were eliminated or if unhealthy foods were included.

Nurture Early for Optimal Nutrition (NEON) participatory learning and action women’s groups to improve infant feeding and practices in South Asian infants: pilot randomised trial study protocol

IntroductionFeeding practices developed in early life can impact a child’s nutrition, growth, dental health, cognitive development and lifetime risk of chronic diseases. Substantial evidence suggests ethnic health inequalities, and non-recommended...

Infant Complementary Feeding Methods and Subsequent Occurrence of Food Neophobia-A Cross-Sectional Study of Polish Children Aged 2-7 Years.

The study used an anonymous survey questionnaire consisting of five parts as the research tool. The first part of the questionnaire was a metric and concerned the socio-demographic data of the parent/guardian and their child. A standardised questionnaire assessing food neophobia among children was used to assess food neophobia: the Food Neophobia Scale-Children (FNSC). In the study group, 171 children (29.23%) had a low risk of food neophobia according to the FNSC, 182 children (31.11%) had a medium risk of neophobia, and 232 children (39.66%) had a high risk of neophobia. A correlation was observed between the age and the risk of food neophobia (p = 0.0002). Statistically significant differences were found between children aged 2 and 4 (p = 0.003) and children aged 2 and 5 years (p = 0.049). We observed no correlation between gagging (p = 0.88557), choking (p = 0.17597), and needing medical intervention (p = 0.61427) and the risk of associated neophobia. In the study group of children, the highest risk of food neophobia was characterized by children aged 4, 5, and 7 years. The length of breastfeeding and exclusive breastfeeding did not affect the risk of food neophobia. In the month in which complementary feeding (CF) was introduced, the children were fed using the baby-led weaning method (BLW method), and introducing puree and puree with lump food into the children's diet also did not affect the risk of food neophobia. It was shown, however, that children whose mothers observed difficulties during CF and whose children had a vomiting reflex and spat food out of their mouths during CF were more likely to develop food neophobia at the preschool age.

Actions for the protection and prevention of sustainable healthy complementary feeding in nurseries

Abstract Background The WHO and UNICEF in the Global Strategy for infant and young children feeding (GS), indicate that the principle actors of society play significant roles in protecting, promoting and supporting safe and adequate complementary feeding for infants and young children. The WHO and FAO in The Sustainable Healthy Diet, guiding principles (SHD) moreover underline synergies among foods, nutrients present in dietary patterns and their bioavailability, degree of food processing, and subsequent health impact. COVID-19's (C) social economic impact has changed food supply costs. The UNICEF Baby-Friendly Community Initiative, involving 41 nurseries with 1600 enrolled children and a coverage rate of 38% (EU objective 35%) has operated in the municipality of Trieste, since 2015. Beginning August 2022 the project aims were to verify the application of food safety regulations (FSR), recommendation of the GS, SHD and regional nutritional guidelines (RNG) in nursery catering services. Methods 13 nurseries have been verified. 78 food samples (FS) of oven-cooked vegetables (V), meat and fish (MF) were taken from 10 nursery kitchens, with a total production of 1150 meals per day. The University of Trieste has performed over 400 analyses. The outcomes were compared with FSR, literature references and pre C research results carried out in 2015. Results Relevant and systemic corrective actions indicated by FSR, GS and RNG have been implemented to overcome non-compliance. The analyses performed on FS have shown that the protective compounds have remained similar, and in some cases improved, in V foods. However, in the MF-based oven-cooked preparations, a significant content of Maillard products was highlighted and only some of them showed values above the acceptable limit. Conclusions The evidence of the project will be able to orient public actors for future integrated actions of protection, promotion and support of a healthy and sustainable complementary diet after C. Key messages • After the social economic impact of the Covid-19 pandemic it is determinant to support public actors in continuing to protect, promote and support safe and adequate complementary feeding in nurseries. • It is crucial to program systemic and coordinated actions to ensure adequate resilient food systems in nursery catering services in adherence with the WHO, FAO and UNICEF recommendations.

Timing of complementary feeding for early childhood allergy prevention: An overview of systematic reviews.

To summarise and critically appraise systematic review (SR) evidence on the effects of timing of complementary feeding (CF) on the occurrence of allergic sensitisation and disease. Overview of SRs. AMSTAR-2 and ROBIS were used to assess methodological quality and risk of bias (RoB) of SRs. RoB 2 Tool was used to assess RoB of primary randomised controlled trials (RCTs) (or extracted). The certainty of evidence (CoE) was assessed using GRADE. Findings were synthesised narratively. MEDLINE (via PubMed and Ovid), the Cochrane Library and Web of Science Core Collection (2010 to 27 February 2023). SRs investigating the effects of timing of CF in infants or young children (0-3 years) on risk of developing food allergy (FA), allergic sensitisation, asthma, allergic rhinitis, atopic eczema and adverse events based on RCT evidence. Eleven SRs were included. Only two SRs had low RoB; common issues were failure to report on funding of primary studies and failure to provide a list of excluded trials. Common limitations of included trials were lack of blinding of outcome assessment or detailed trial preregistration, and inadequate handling of high loss to follow up. Primary study overlap was very high for specific FA and slight to moderate for FA in general and other primary outcomes. Introducing specific foods (peanut, cooked egg) early probably reduces the risk of specific FA. Evidence forother allergic outcomes was mostly very uncertain and based on few primary studies. Trials varied regarding timing of CF, nature of complementary foods and population risk, which limited comparability between SRs. For developing guidelines to support decision-making on the timing of CF as a preventive strategy, early introduction of specific foods (i.e. egg and peanut) seems promising and safe, whereas more extensive research is required regarding other allergic outcomes and potential adverse events.

AI-ASSISTED emotion analysis during complementary feeding in infants aged 6–11 months

This study aims to explore AI-assisted emotion assessment in infants aged 6–11 months during complementary feeding using OpenFace to analyze the Actions Units (AUs) within the Facial Action Coding system. When infants (n = 98) were exposed to a diverse range of food groups; meat, cow-milk, vegetable, grain, and dessert products, favorite, and disliked food, then video recordings were analyzed for emotional responses to these food groups, including surprise, sadness, happiness, fear, anger, and disgust. Time-averaged filtering was performed for the intensity of AUs. Facial expression to different food groups were compared with neutral states by Wilcoxon Singed test. The majority of the food groups did not significantly differ from the neutral emotional state. Infants exhibited high disgust responses to meat and anger reactions to yogurt compared to neutral. Emotional responses also varied between breastfed and non-breastfed infants. Breastfed infants showed heightened negative emotions, including fear, anger, and disgust, when exposed to certain food groups while non-breastfed infants displayed lower surprise and sadness reactions to their favorite foods and desserts. Further longitudinal research is needed to gain a comprehensive understanding of infants' emotional experiences and their associations with feeding behaviors and food acceptance.

P07-066-23 Maternal Mental Health and Infant Complementary Feeding Practices

P07-066-23 Maternal Mental Health and Infant Complementary Feeding Practices

Impact of Maternal Education on Breast Feeding and Complementary Feeding Practices of Infants

Objectives: To determine the impact of maternal education on incidence of breast feeding, duration and infant complementary feeding practices.&#x0D; Methodology: A Cross sectional study done in Department of Paediatric medicine, University of Lahore Teaching Hospital ,Lahore from October 2020 to March 2021. Non probability consecutive sampling technique, total 198 mothers having child 6 to 12 months were enrolled in study after approval of hospital ethical committee and informed consent from mother. Data was entered and analyzed using SPPS 22.&#x0D; Results: Breast feeding was adopted by 62.8% mothers. Mean duration of breast feeding was 8.52±3.1 months. Regarding initiation of breast feeding 35.1% started immediately after delivery. Regarding introduction of solid feed 27.3% started before 6 months of age. Pre lacteal was given in 35.5% infants. There was no impact of maternal education on frequency of breast feeding, p-value 0.328 but duration of breast-feeding was longer in mother having graduation as compared to mothers having education less than matric i.e. 8.77±2.977 months vs 7.82±3.384 months.&#x0D; Conclusion: Mothers with higher education have greater duration of breast-feeding ad compared to mother with less education.

The Influence of Applying the Baby-Led Weaning (BLW) Method in the Feeding of Complementary Feeding in Infants

Baby-Led Weaning is a method to introduce complementary foods to babies aged 6 months or older. Weaning or the introduction of complementary foods of breast milk can be a major role in the future growth and health of the baby. This research design uses the Literature Review method. The articles were obtained from keyword searches in the Google Scholar, Pubmed and Scient Direct databases with publications ranging from 2018-2022 in English. The results of the study which are in accordance with the inclusion state that the Baby-Led Weaning method is very influential in giving MP-ASI from an early age to infants. The results of the analysis of 5 journals found that the use of the baby Led Weaning method affects nutritional intake, oral motor development, and body weight, besides that it affects the duration of feeding and even affects the incidence of choking.

A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

Background and aimsWith an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings. MethodsWe systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022. ResultsOur search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the “Scope and Purpose” and “Rigour of Development” domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the “Applicability” domain were generally low, and only 3 CPGs rated highly in the “Implementability” domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably. ConclusionThe overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders’ preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe. PROSPERO registration numberCRD42021265689.

A Peer-Led Integrated Nutrition Education Intervention through Care Groups Improved Complementary Feeding of Infants in Postemergency Settlements in the West-Nile Region in Uganda: A Cluster Randomized Trial

BackgroundComplementary feeding of infants in refugee settlements remains inadequate. Furthermore, there has been limited evaluation of interventions addressing these nutrition challenges. ObjectiveThis study examined the effects of a peer-led integrated nutrition education intervention on infant complementary feeding by South Sudanese refugee mothers in the West-Nile region in Uganda. MethodsA community-based randomized trial enrolled 390 pregnant women (during third trimester) as the baseline. Two arms [mothers-only and parents-combined (both mothers and fathers)] comprised treatments with a control. Infant feeding was assessed using WHO and UNICEF guidelines. Data were collected at Midline-II and Endline. The medical outcomes study (MOS) social support index was used to measure social support. An overall mean score of >4 was considered optimal social support, a score of ≤2 was none or little support. Adjusted multivariable logistic regression models determined the effects of the intervention on infant complementary feeding. ResultsAt the end of the study, infant complementary feeding improved significantly in both mothers-only and parents-combined arms. There was a positive effect on the introduction of solid, semisolid, and soft foods (ISSSF) in the mothers-only arm at both Midline-II {adjusted odds ratio (AOR) = 4.0]} and Endline (AOR = 3.8). Likewise, ISSSF was better for the parents-combined arm at both Midline-II (AOR = 4.5) and Endline (AOR = 3.4). Minimum dietary diversity (MDD) was significantly better at the Endline for the parents-combined arm (AOR = 3.0). Minimum acceptable diet (MAD) was significantly better at Endline for both mothers-only (AOR = 2.3) and parents-combined arms (AOR = 2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the parents-combined arm at both Midline-II (AOR = 3.3) and Endline (AOR = 2.4). Higher maternal social support was associated with better infant MDD (AOR = 3.3), MAD (AOR = 3.6), and EFF (AOR = 4.7). ConclusionEngaging both fathers and mothers in care groups benefited complementary feeding of infants. Overall, this peer-led integrated nutrition education intervention through care groups improved infant complementary feeding in the West-Nile postemergency settlements in Uganda.This trial was registered at clinicaltrials.gov as NCT05584969.