Complementary Feeding Of Infants Research Articles

Parental experiences and perceptions of infant complementary feeding: a qualitative evidence synthesis.

Interventions to prevent childhood obesity increasingly focus on infant feeding, but demonstrate inconsistent effects. A comprehensive qualitative evidence synthesis is essential to better understand feeding behaviours and inform intervention development. The aim of this study is to synthesize evidence on perceptions and experiences of infant feeding and complementary feeding recommendations. Databases CINAHL, EMBASE, MEDLINE, PsycINFO, Academic Search Complete, SocIndex and Maternity and Infant Care were searched from inception to May 2017. Eligible studies examined parents' experiences of complementary feeding of children (<2years). Data were synthesized using thematic synthesis. Twenty-five studies met inclusion criteria for review. Four key themes emerged. 'Guidelines and advice' highlights variety and inconsistencies between sources of complementary feeding information. 'Stage of weaning' describes infant feeding as a process involving different stages. 'Knowing and trying' outlines parents' engagement in feeding approaches based on instinct, prior experience or trial and error. 'Daily life' highlights problematic cost and time constraints for parents. Parents predominantly understand and want to engage in healthy feeding processes. Consideration of infant feeding as a process that changes over time is necessary to support parents. Provision of clear, consistent information and guidance from trusted sources on when, what and how to feed is also essential.

Poor nutrition from first foods: A cross-sectional study of complementary feeding of infants and young children in six remote Aboriginal communities across northern Australia.

To describe the first foods of Aboriginal and Torres Strait Islander infants and young children who were recruited to a nutrition promotion and anaemia prevention program conducted from 2010 to 2012, in six remote communities across northern Australia. Food records (24-hour diet history, food variety checklist) were completed on recruitment by interview with a parent or carer. Cross-sectional analysis assessed the proportion of participants consuming recommended and not-recommended foods and drinks and meeting recommendations for meal frequency and dietary diversity. Of 245 Aboriginal and Torres Strait Islander participants aged 6-24 months, 227 (92.7%) had a recruitment food record. On the previous day, most (67.4%) had breastmilk, nearly all (98.2%) ate solid food, but only 13% ate fruit, 33% had neither fruit nor vegetables, and 25% had sweet drinks. Children living in smaller households (3-5 people) were more likely to meet the criteria for frequency of meals than those living in larger households of 12-31 people (93% vs 78%, P = 0.012 for trend over household size). Only 30% met the criteria for dietary diversity. Where information was available (n = 91), dietary diversity was adequate more often in 'pay week' compared to 'not pay week' (31.3% vs 9.3%, P = 0.007). Support for current beneficial breast-feeding practices and promotion of nutrient-dense complementary foods, need to be embedded in initiatives for improved family food security. Good nutrition in early life can reduce the disparity in health, education and economic status between Aboriginal and Torres Strait Islander peoples and other Australians.

Evaluation of programs to improve complementary feeding in infants and young children

Evaluation of complementary feeding programs is needed to enhance knowledge on what works, to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs, presenting concepts and methods and illustrating them through examples. Planning and investments for evaluations should occur from the beginning of the project life cycle. Essential to evaluation is articulation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit the dynamic connections in the program theory and accounts for contextual factors that could influence program effectiveness. Evaluating implementation functioning is done through addressing questions about needs, coverage, provision, and utilization using information obtained from process evaluation, operations research, and monitoring. Evaluating effectiveness is done through assessing impact, efficiency, coverage, process, and causality. Plausibility designs ask whether the program seemed to have an effect above and beyond external influences, often using a nonrandomized control group and baseline and end line measures. Probability designs ask whether there was an effect using a randomized control group. Evaluations may not be able to use randomization, particularly for programs implemented at a large scale. Plausibility designs, innovative designs, or innovative combinations of designs sometimes are best able to provide useful information. Further work is needed to develop practical designs for evaluation of large-scale country programs on complementary feeding.

Vivência de mães na conciliação entre aleitamento materno e estudos universitários

Objetivo: Comprender la experiencia de las madres en la conciliación entre la lactancia materna y los estudios universitarios.Metodología: Estudio descriptivo y cualitativo, en el cual se incluyeron ocho estudiantes de una institución de educación superior del municipio de Floriano, Piauí, Brasil. Para la recolección de datos, se utilizó una entrevista semiestructurada. Los datos fueron analizados por medio de la técnica de análisis de contenido de Bardin.Resultados:Con base en el análisis de los datos, surgieron tres categorías: Los desafíos para amamantar frente al retorno a las actividades académicas; La necesidad de apoyo familiar en la experiencia de la lactancia materna; y Las estrategias utilizadas por las madres para la alimentación del niño en el retorno a las actividades académicas. Los desafíos en la experiencia de la lactancia materna involucraron una carga horaria excesiva y horarios rígidos para el desarrollo de las actividades académicas, además de la falta de un ambiente adecuado para llevar a cabo la lactancia materna en la institución educativa. En cuanto a la necesidad del apoyo familiar, las madres universitarias informaron que ésta fue insuficiente en la experiencia de conciliar la lactancia materna con la vida académica. Respecto a las estrategias de las madres en el retorno a las actividades académicas para la alimentación del niño, se identificaron: la extracción manual de leche materna, el uso de leche industrializada, la inclusión de alimentación complementaria y la interrupción de la lactancia según la actitud del niño.Conclusión: Las madres universitarias percibieron la experiencia de la lactancia materna como un desafío y la describieron con estrategias y técnicas que apuntan a mantenerla

Protocol for a systematic review on health outcomes related to the age of introduction of complementary food for the scientific assessment of the appropriate age of introduction of complementary feeding into an infant's diet.

In 2016, the European Food Safety Authority (EFSA) received a mandate from the European Commission to update its 2009 opinion on the appropriate age for introduction of complementary feeding of infants. In order to retrieve data on health outcomes related to the age of introduction of complementary food, a systematic literature review will be conducted in line with the EFSA guidance on the application of systematic review methodology to food and feed safety assessments to support decision making. These data will be considered together with data on the nutritional adequacy of exclusive breastfeeding or formula feeding at different ages and with data on neuromuscular, gastrointestinal and renal development which may affect the capacity of the infant to introduce non‐milk foods in the diet as the basis for the scientific assessment. This protocol serves as a basis for conducting the systematic literature search aiming to retrieve data on health outcomes related to the age of introduction of complementary food. As EFSA wished to seek advice from stakeholders on the draft protocol for the systematic literature review, the NDA Panel endorsed the draft protocol for public consultation on 1 February 2017. The consultation was open from 16 February to 23 March 2017 (5 weeks).

Association between maternal social capital and infant complementary feeding practices in rural Ethiopia.

Few studies have explored the potential of social capital in improving child nutritional status; however, most components of pathways between social capital and nutritional status have remained unexplained. Complementary feeding practice is a strong mediator of child nutritional status. This study examined the association between complementary feeding practice and maternal social capital in rural Ethiopia, using cross-sectional data of infant aged 6-12months and their mother pairs (n=870). The Short Social Capital Assessment Tool was used to assess maternal structural (i.e., community group membership, having emotional/economic support from individuals, and citizenship activities) and cognitive social capital (i.e., trust, social harmony, and sense of belonging) in the past 12months. Infant's dietary diversity score (DDS, range: 0-7), minimum dietary diversity (MDD), and minimum meal frequency (MMF) were assessed using a 24-hr dietary recall. Multivariable ordinal/binary logistic regression analyses were conducted. Having support from two or more individuals was associated with higher DDS (OR=1.84) and meeting a minimum level of dietary diversity (MDD: OR=5.20) but not with MMF, compared to those having no support. Having two or more group memberships was associated with higher DDS (OR=2.2) but not with MDD or MMF, compared to those without group membership. Citizenship activities showed mixed associations with MMF and no association with DDS or MDD. Cognitive social capital showed no association with DDS or MDD and lower odds of meeting MMF (OR=0.56). These mixed results call for further studies to examine other potential pathways (e.g., hygiene and caring behaviours) in which social capital could improve child nutritional status.

Diet diversity, growth and adiposity in healthy breastfed infants fed homemade complementary foods.

Infant complementary feeding is important for establishing food preferences. Few studies exist on the effects of infant complementary feeding choices (food preparation methods) on dietary intake, growth or adiposity. We examined whether provision of homemade complementary food is associated with the development of dietary diversity, nutrient intakes and quality of infant growth. Secondary analysis of feeding practices from a randomized trial of vitamin D supplementation in 132 healthy breastfed 1-month-old infants from Montréal, Canada. This longitudinal study used diet records, anthropometric and body composition data (dual-energy X-ray absorptiometry) from assessments that occurred when infants were 6, 9, 12 and 36 months of age. Infants were grouped into three categories of food preparation method on the basis of whether or not they had consumed homemade or commercial meat or fruit and vegetable by 9 months (homemade, commercial and both). Multivariable regression controlled for family income, maternal education and infant sex. Dietary data were available for 65 infants. By 9 months, 22% of infants had exclusively received homemade (n=14), 14 infants had exclusively received commercial and 37 infants had received both. The development of dietary diversity (number of World Health Organization-recommended food groups) was higher (0.76 (95% confidence interval (CI): 0.14, 1.38); P<0.05) in the homemade group versus commercial. Energy and nutrient intakes did not differ by group over time. The homemade group had 773 g (-1364, -182; P<0.01) lower whole-body fat mass and 7.1% (-12.6, -1.6; P<0.05) lower % body fat at 12 months compared with the reference group (both homemade and commercial). Reduced whole-body fat mass in the homemade group persisted at 36 months (-696 g (95% CI: -1341, -52); P<0.05). There were no differences between groups for changes in growth Z-scores (length-for-age, weight-for-age and body mass index-for-age). Provision of homemade complementary food is associated with increased dietary diversity during the first year of life and reduced adiposity.

An exploration of complementary feeding of infants and young children in the rural area of Muhoroni, Nyanza province, Kenya: a descriptive study

Background: Inappropriate infant and young child feeding practices contribute to malnutrition, infection and long-term development limitation.Aims: To explore complementary feeding and food safety in Muhoroni District, Nyanza Province in rural Kenya.Objectives: To compare practices with the Infant and Young Child Feeding (IYCF) guidelines, and identify associations with inappropriate practices.Methods: Between January and April 2014, a questionnaire completed by primary caregivers of children aged 6–23 months asked about foods the child had received in the previous 24 hours, the introduction of complementary foods, and the food hygiene practices undertaken by the caregiver. The most recent World Health Organization IYCF core indicators (continued breastfeeding at 1 year; minimum dietary diversity; minimum meal frequency; minimum acceptable diet) were determined for 400 children. These indicators were compared with demographic indicators in multivariate analyses to identify associations with appropriate complementary feeding practices.Results: A total of 55.2% of children aged 12–15 months continued to be breastfed at the time of questioning. Of the study population, 61.5% achieved minimum dietary diversity, 70.8% achieved minimum meal frequency and 43.0% achieved minimum acceptable diet. Older children were more likely to achieve minimum dietary diversity and minimum acceptable diet; however, they were also less likely to achieve minimum meal frequency. High levels of hygiene practices were reported in all areas of food safety.Conclusion: Complementary feeding indicators were higher than nationally, although less than half of children (43.0%) were receiving a minimum acceptable diet. Further work should explore the potential relationship between age and adequate infant feeding.

Appropriate infant feeding: a survey of mothers' practices in Magboro, Ogun State

Background: The practice and transition from exclusive breastfeeding to family foods is a vulnerable period in every child's life. Poor breastfeeding and complementary feeding practices have been widely documented in the developing countries. Only about 39% of infants in the developing countries, and 25% in Africa are exclusively breastfed for the first six months. Up to 6% of infants in developing countries are never breastfed. Objective: The study aims to determine what mothers in Magboro, Ogun state know about infant feeding and its practices. Method: This was a descriptive cross sectional study among one hundred and seventy four mothers of underfive children selected by multistage sampling in Magboro Ogun State. Data were collected about knowledge, attitudes and practices of exclusive breastfeeding (EBF) and complementary infant feeding (CIF), and the sociodemographic correlates using interviewer administered questionnaires. Data were analysed with Epi info ver 6, results presented as frequencies and associations tested statistically with Chi-square at a significance level of 0.05. Results: Correct knowledge of breastfeeding and complementary feeding was reported by 73.6% and 76.4% of mothers respectively. Exclusive breastfeeding for 6 months was done by 29.9% of mothers, 49.4% introduced complementary feeding at 6 months and 24.1% commenced before 6 months. There were statistically significant associations between the age of mothers, monthly household income, and exclusive breastfeeding for 6 months. Conclusion: This study confirms there are a few knowledge gaps concerning exclusive breastfeeding and complementary feeding, however, a significant knowledge-practice gap exists regarding EBF and CIF. The authors recommend that more community-based educational support is introduced. Further research on appropriate channels of health education is needed Keywords: Infant feeding, complementary infant feeding, exclusive breastfeeding, Nigeria

Historical Overview of Transitional Feeding Recommendations and Vegetable Feeding Practices for Infants and Young Children.

Although recommendations for introducing solid foods to infants and young children have changed significantly since the beginning of the 20th century, vegetable consumption recommendations have always been an important part of the child-feeding repertoire. In 1958, the first report of the American Academy of Pediatrics (AAP) Committee on Nutrition stated that developmental maturity of the gut and neuromuscular system, growth rate, and activity level were good indicators for determining when to introduce solid foods to infants than age. All 7 editions of the AAP Pediatric Nutrition Handbook use an evidence-based model for recommendations concerning the complementary feeding of infants and young children. The model includes developmental readiness principles, feeding practices, and age-appropriate nutrient requirements. Dietary patterns and nutrient consumption among infants and young children have been analyzed using data from the 2002 and 2008 Feeding Infants and Toddlers Study (FITS). The 2008 FITS also collected information concerning participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Since 1972, WIC has been a cost-effective means of improving the diets and health of infants and young children from low-income families. Data from the 2008 FITS showed that many young children did not consume recommended amounts of fiber or potassium, and vegetable and fruit intakes continued to be lower than recommended. Low vegetable consumption and limited variety were also seen among WIC participants and nonparticipants aged 6 months to 4 years prior to changes in the WIC food package. Increasing children’s consumption of all vegetables should continue to be a focus going forward.

Caterpillar cereal as a potential complementary feeding product for infants and young children: nutritional content and acceptability

Micronutrient deficiency is an important cause of growth stunting. To avoid micronutrient deficiency, the World Health Organization recommends complementary feeding with animal-source foods. However, animal-source foods are not readily available in many parts of the Democratic Republic of Congo (DRC). In such areas, caterpillars are a staple in adult diets and may be suitable for complementary feeding for infants and young children. We developed a cereal made from dried caterpillars and other locally available ingredients (ground corn, palm oil, sugar and salt), measured its macro- and micronutrient contents and evaluated for microbiologic contamination. Maternal and infant acceptability was evaluated among 20 mothers and their 8-10-month-old infants. Mothers were instructed in the preparation of the cereal and asked to evaluate the cereal in five domains using a Likert scale. Mothers fed their infants a 30-g portion daily for 1 week. Infant acceptability was based on cereal consumption and the occurrence of adverse events. The caterpillar cereal contained 132 kcal, 6.9-g protein, 3.8-mg iron and 3.8-mg zinc per 30 g and was free from microbiologic contamination. Mothers' median ratings for cereal characteristics were (5 = like very much): overall impression = 4, taste = 5, smell = 4, texture = 4, colour = 5, and consistency = 4. All infants consumed more than 75% of the daily portions, with five infants consuming 100%. No serious adverse events were reported. We conclude that a cereal made from locally available caterpillars has appropriate macro- and micronutrient contents for complementary feeding, and is acceptable to mothers and infants in the DRC.

Household food security and infant feeding practices in rural Bangladesh.

To determine the association between household food security and infant complementary feeding practices in rural Bangladesh. Prospective, cohort study using structured home interviews during pregnancy and 3 and 9 months after delivery. We used two indicators of household food security at 3-months' follow-up: maternal Food Composition Score (FCS), calculated via the World Food Programme method, and an HHFS index created from an eleven-item food security questionnaire. Infant feeding practices were characterized using WHO definitions. Two rural sub-districts of Kishoreganj, Bangladesh. Mother-child dyads (n 2073) who completed the 9-months' follow-up. Complementary feeding was initiated at age ≤4 months for 7 %, at 5-6 months for 49 % and at ≥7 months for 44 % of infants. Based on 24 h dietary recall, 98 % of infants were still breast-feeding at age 9 months, and 16 % received ≥4 food groups and ≥4 meals (minimally acceptable diet) in addition to breast milk. Mothers' diet was more diverse than infants'. The odds of receiving a minimally acceptable diet for infants living in most food-secure households were three times those for infants living in least food-secure households (adjusted OR=3·0; 95 % CI 2·1, 4·3). Socio-economic status, maternal age, literacy, parity and infant sex were not associated with infant diet. HHFS and maternal FCS were significant predictors of subsequent infant feeding practices. Nevertheless, even the more food-secure households had poor infant diet. Interventions aimed at improving infant nutritional status need to focus on both complementary food provision and education.

Age of introduction of first complementary feeding for infants: a systematic review.

BackgroundDespite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age, it is not clear what the health implications may be. Breast milk alone may not meet the nutrition needs for all growing infants, leaving them at risk for deficiencies. The objective of this study was to investigate the relationship between moderate (4 months) versus late (6 months) introduction of complementary foods to the full-term breastfed infant on iron status and growth.MethodsAn electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.ResultsThree RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95 % CI: 1.5, 8.5 g/L; P = 0.005]. Meta-anaysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95 % CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95 % CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.ConclusionsRCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0409-5) contains supplementary material, which is available to authorized users.

The Chilean Health Care System: the task ahead

The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile's health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children < 5 years old (from 63% to 0.5%); and upward trends in life expectancy at birth (from 50 to 79,8 years), professional hospital care of births (from 35% to 99.8%), access to drinking water (from 52% to 99%), and access to sanitary sewer (from 21% to 98.9%). This went hand in hand with an improvement in economic and social indexes: per capita income at purchasing power parity increased from US$ 3,827 to US$ 20,894 and poverty decreased from 60% to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care which such a system would demand requires a sustainable growth of the Chilean economy.

Knowledge and Practices of Mothers: Infant and Young Child’s Feeding in Chowk Azam, the Punjab, Pakistan

In order to investigate the knowledge and practices of mothers regarding breast feeding and complementary feeding and to assess their compliance with the health guidelines, we conducted a cross-sectional survey of infant complementary feeding and breast feeding practices was conducted in a sample of 230 mothers. Data was collected systematically from rural areas of Chowk Azam. A validated questionnaire comprising of questions pertaining to sociodemographic profile, knowledge and practices of breast feeding and complementary feeding practices was used. The data was analyzed using SPSS version 20 and chi square test was applied.Our study resultsrevealed thatonly 18% mothers were practicing complementary feeding at the recommended age. About 72% of the respondents started complementary feeding before the recommended age of six months and 3% mothers started delayed complementary feeding. Around 6.5% mothers had children less than six months of age and did not start complementary feeding yet. Almost half of the respondents 56.3%were using the homemade complementary food, while less than a fourth i.e. 19.5% mothers were giving commercially prepared food to their children and rest of one-fourth mothers 24.2% were giving both types of food. We conclude that knowledge and practices of mothers pertaining to breast feeding and complementary feeding practices are at mixed levels, and their understanding aboutexact time of starting complementary feeding is suboptimal. There is a need to create awareness among mothers regarding theappropriate time of starting complementary feeding so that health status of the infants and children can be ameliorated.

The impact of health workers' training on breastfeeding and complementary feeding practices

This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazil's Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56±1.91 months in the FHP intervention and 2.32±1.63 months in the HCC intervention) compared to the HCC control group (1.91±1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

Household food security and infant feeding practices in rural Bangladesh (378.1)

To identify predictors of infant complementary feeding (CF) practices in rural Bangladesh, we studied pregnant women and their infants followed‐up at age 3 and 9 mo. Information on sociodemographics, maternal diet, and infant diet and feeding practices were collected by interview. Maternal food composition score (FCS) at infant age 3 mo, calculated via the World Food Programme method and dichotomized at the median, was used as an indicator of household food security, the main exposure. Multiple logistic regression was used to identify predictors of infant feeding practices.2078 mother‐child dyads completed the 9 mo follow‐up. CF was initiated at age 蠄 4 months for 4.3%, at 5‐6 months for 50%, and 蠅 7 months for 45% of infants. Based on 24‐hour dietary recall, 97.8% of infants were still breastfeeding at age 9 months, 16.4% received 蠅 4 food groups and 16.1% received a minimum acceptable diet (i.e. 蠅 4 food groups and 蠅 4 meals in addition to breastmilk). Infants from households with higher maternal FCS at 3 mo were more likely to receive 蠅 4 food groups (aOR = 2.1; 95% CI = 1.6, 2.7) and a minimum acceptable diet (aOR = 2.0; 95% CI = 1.5, 2.6) at 9 mo. SES, maternal age, literacy and parity were not associated with either outcome.Maternal FCS is a good predictor of subsequent infant feeding practices. Households with poor maternal FCS are likely to also have poor infant diet, and hence might benefit from interventions to improve both.

Nutrient density in complementary feeding of infants and toddlers

The paradigm of the first 1000 days of life, the period from conception to the second birthday, has been advanced as a critical window of opportunity to save a life and a child's future. Infancy and toddler life, through the first 24 months after birth, is a unique period during which human milk is recommended as either the exclusive source of nutrition (6 months) or a variable component thereof. After the maternal delivery of milk is accounted for, the remainder of the energy and nutrients needs come from complementary foods. There is an intrinsic gap left by the maternal milk supply in volume and micronutrient content in relation to expanding infant and toddler needs. The nutrient density approach provides us with a mathematical framework to manage the closing of the nutrient gap. The intrinsic nutrient content of the unprocessed foods appropriate for young children is limited. The most problematic nutrients are calcium, iron and zinc. Some manner to enhance the nutrient density of the complementary foods is an incontestable necessity. The nutrient density consideration, which identifies for us the nature of the problem, offers a tool for the titrating of the fortification to an adequate--but safe--addition.

Assessment of Chemical, Rheological and Sensory Properties of Fermented Maize-Cardaba Banana Complementary Food

Traditional processing of fermented maize (“ogi”), a popular weaning food in the West African sub-region, results in considerable nutrient losses. Several attempts at improving its nutritional and sensory properties have focused on fortification with plant and animal products. Banana flour, rich in micronutrients and vitamins, could increase the micronutrient and vitamin contents of ogi. This study aimed at evaluating the physicochemical properties and sensory attributes of ogi as influenced by banana flour supplementation. Fermented maize flour was substituted with ripe Cardaba banana flour at levels of 10% - 50% and the flour mixes subjected to chemical, rheological and sensory evaluation. Crude protein decreased from 1.59% to 1.43% as banana flour substitution increased, while ash, total sugar (3.64% to 4.97%), carbohydrate and acidity increased. However, diastatic activity, crude fibre and fat were not significantly (p ≤ 0.05) affected. Results of functional properties revealed the following: 86.49 - 83.63 g/ml, 0.41 - 0.44 g/cm3, 6.44 - 7.46 g/ml, 3.30 - 4.50 g/ml, and 10.40 - 10.80 g/ml for water absorption capacity, bulk density, gel consistency, syneresis and swelling capacity, respectively. Significant (p ≤ 0.05) variations were observed in the pasting viscosities of the flours. The 50:50 maize-banana flour mix was the most preferred in terms of aroma, taste, colour and general acceptability. The addition of Cardaba banana flour to ogi may enhance its micronutrient content as evidenced by increased ash content, sensory, functional and pasting properties, thereby making it a potential substitute for complementary feeding of infants.

Introduction of complementary feeding for infants: a dilemma for parents and caregivers

Data are scarce with respect to infant iron status, but at least in developing country settings where newborn iron stores may be suboptimal, exclusive breastfeeding without iron supplementation through 6 months may compromise hematologic status (WHO 2002). Our objective was to systematically review the scientific literature regarding iron and hematologic status among infants breastfed exclusively to 6 months, stratified by developed versus developing countries.MethodsAn electronic search of the MEDLINE database was conducted for studies of iron deficiency (ID) and (IDA) in infants exclusively breastfed in developed and developing countries. Prevalence estimates were calculated as weighted averages, and compared using a 2‐sided test of proportions.ResultsTwenty nine observational studies and three of eight RCTs met the inclusion criteria. All RCTs were conducted in developing countries. The prevalence estimates for healthy exclusively breastfed infants living in developed (n=769) and developing (n=642) countries, respectively, was 21.9% and 14.1% for ID (p = 0.0001), and 12.2% and 18.2% (p= 0.0019).ConclusionA substantial proportion of exclusively breastfed infants develop ID, IDA, and compromise hematologic status in both developed and developing countries. Data to support the current recommendation of solid commencement at six months is limited regarding irons status. Larger randomized controlled trials, perhaps in multi centre design, are needed to investigate the advantages and disadvantages of introduction of solids before and after six months of age.