Introduction Of Complementary Foods Research Articles

Preventing Atopic Diseases During Childhood - Early Exposure Matters.

Atopic diseases in childhood are a major burden worldwide and there is still a lack of knowledge about treatable causes. In industrialized countries such as Germany, almost every second child is sensitized to at least one common allergen. Recent studies show that although the predisposition to allergies is inherited, the adaptive immune system of neonates and infants follows a developmental trajectory and whether an allergy actually occurs depends also on timing of allergen exposure including diet as well as environmental factors. New recommendations are far from being rigid of allergen avoidance; it is rather moving toward conditions that stand for more biodiversity. The observation that introduction of peanuts or eggs early in life significantly reduced the development of a later allergy will change our recommendations for the introduction of complementary foods. This is consistent with the hygiene hypothesis that early provocation shapes the developing immune system so that it reacts appropriately. Therefore, promoting the development of tolerance is at the heart of sensible allergy prevention - and this begins with the last trimester of pregnancy. In light of this concept, actual recommendations are discussed.

Complementary Feeding Practices and Parental Pressure to Eat among Spanish Infants and Toddlers: A Cross-Sectional Study.

The introduction of complementary foods is a crucial stage in the development and determination of infants’ health status in both the short and longer-term. This study describes complementary feeding practices among infants and toddlers in Spain. Also, relationships among sample characteristics (both parents and their child), feeding practices (timing, type of complementary food), and parental pressure to eat were explored. Cognitive interviewing with 18 parents was used to refine the survey questions. Responses from a national random sample of 630 parents, who were responsible for feeding their infants and toddlers aged 3–18 months, were obtained. Solids, often cereals and/or fruits first, were introduced at a median age of five months. Fish and eggs were introduced around the age of nine and ten months. Almost all children were fed with home-prepared foods at least once per week (93%), and in 36% of the cases, salt was added. Interestingly, higher levels of parental pressure to eat were found in female infants, younger parents, parents with a full-time job, the southern regions of Spain, and in infants who were not fed with home-prepared foods. Our insights underline the importance of clear feeding recommendations that can support health care professionals in promoting effective strategies to improve parental feeding practices.

Climatic Conditions and Infant Care: Implications for Child Nutrition in Rural Ethiopia.

We examine the relationships between climatic conditions, breastfeeding behavior, and maternal time use in Ethiopia. Infant feeding practices are important predictors of child nutrition that may be affected by a number of factors including mother's time engaging in agricultural labor, food security, cultural beliefs, and antenatal care. We use panel data from the Living Standards Measurement Study to investigate linkages between climatic conditions during a child's first year of life and year prior to birth and duration of exclusive breastfeeding. We then explore one potential mechanism: women's agricultural labor. Results indicate that rainfall during the primary agricultural season-kiremt-in a child's first year of life plays an important role in duration of exclusive breastfeeding. Experiencing 25 cm of average monthly kiremt rainfall, versus 5 cm, is associated with a 20-percentage-point decrease in the likelihood of being exclusively breastfed for the recommended six months. More kiremt rainfall is associated with a greater number of days that women spend planting and harvesting, and at high levels of rainfall women with infants do not engage in significantly fewer days of agricultural labor than those without infants. Lastly, we find that during the year before birth, greater rainfall during kiremt as well as the dry season is associated with a lower likelihood of six months of exclusive breastfeeding, potentially due to the early introduction of complementary foods. Our findings indicate that agricultural labor demands may in part drive breastfeeding behaviors, leading to "sub-optimal" feeding practices in the short-term, but resulting in improved household food security in the longer-term.

Nutritional Factors in the Prevention of Atopic Dermatitis in Children.

Atopic dermatitis is one of the most frequent chronic skin diseases worldwide and often develops within the first few years of life. Recent advancements in our knowledge of its pathophysiology have brought to light the role of genetic predisposition and environmental triggers. With the increasing prevalence of allergic diseases, there is a strong need for a better understanding of the various modifiable eliciting factors of such conditions. The concomitant rise in food allergy and insights into the skin barrier function has highlighted the role of nutrition and diet in the prevention and modification of allergic disorders. Furthermore, the identification of the skin as an important route of sensitization, and the risk of progression to asthma later in life, stress the significance of optimizing our management of skin inflammation in the prevention of allergies. Many nutritional factors, including the type of maternal diet during pregnancy, the duration of breastfeeding, the epicutaneous exposure of allergenic food proteins in the first few years of life, the timing of the introduction of complementary foods, the supplementation of vitamins and probiotics/prebiotics during prenatal and early life, have been assessed as potential targets for the prevention of atopy and eczema. Here, we review the latest data addressing prenatal and perinatal nutritional and dietary interventions in the primary prevention of atopic dermatitis. Also, we define knowledge gaps and targets for future research in the prevention of atopic dermatitis.

The risk of inappropriate timing of complementary foods introduction is increased among first-time mothers and poor households

Background: Global recommendations suggest mothers provide the first complementary food to infants when they reach six months of age. Failure to introduce complementary foods promptly may put infants in adverse health and nutrition outcomes. Objective: This study aimed to analyze factors associated with inappropriate timing of complementary foods introduction in Kebumen Regency. Methods: This study used a cross-sectional design. A multistage cluster sampling was employed to select 355 mothers of children aged 6-23 months in Kebumen Regency. Our dependent variable was the timing of complementary food introduction. Meanwhile, independents variables included factors at the child, parental, and household levels. Univariate and multiple logistic regressions were performed in this study. Results: There was 39.15% of young children received inappropriate timing of complementary feeding. Being the second-born child or above (OR=0.56; 95%CI: 0.33-0.95) and coming from high-income households (OR= 0.57; 95%CI: 0.36-0.90) were protective factors of inappropriate timing of complementary foods introduction. Other variables such as maternal age, maternal education, maternal occupation, father’s education, and family support were not significantly associated with incorrect timing of complementary feeding. Conclusions: The proportion of inappropriate timing of complementary foods introduction in Kebumen Regency is alarming and is mainly explained by child’s birth rank and household economic status suggesting the importance of targeting nutritional education to first-time mothers as well as poor households.

Duration of breastfeeding, age at introduction of complementary foods and allergy-related diseases: a prospective cohort study

BackgroundThe influences of breastfeeding and infant diet in the prevention of allergy-related diseases are uncertain and many of the studies conducted on the topic are limited by methodological challenges. Our aim was to assess whether the duration of breastfeeding and age at complementary food introduction affected the prevalence of asthma, wheeze, allergic rhinoconjunctivitis (ARC) and eczema at two and six years of age.MethodsWe used information gathered between 2000 and 2014 through questionnaires in the Prevention of Allergy among Children in Trondheim (PACT) study, a prospective cohort study in Trondheim, Norway. The current study includes 6802 children who submitted questionnaires detailing breastfeeding duration and or age at introduction to complementary foods, as well as at least one of the child health questionnaires completed at two and six years of age. Adjusted odds ratios (aORs) were calculated for each combination of exposure and outcomes and sensitivity analyses were performed to assess the possible influence of recall bias and reverse causality.ResultsThe mean duration of breastfeeding was 11 months (SD 5.6) in this study population and 5695 of 6796 (84%) infants had been breastfed for at least 6 months. We did not find any conclusive preventative effect of longer breastfeeding on parental reported doctor-diagnosed asthma, aOR 0.79 (95% CI 0.51, 1.21). However, at 6 years of age we observed a reduction in the less strictly defined outcome wheeze, aOR 0.71 (95% CI 0.53, 0.95). Longer breastfeeding was associated with a reduced risk of ARC at 2 years, aOR 0.65 (95% CI 0.49, 0.86), with a continued protective trend at 6 years, aOR 0.77 (95% CI 0.58, 1.04).ConclusionsLonger breastfeeding resulted in a reduced risk of wheeze and a trend towards a protective effect on ARC up until school age. No conclusive associations were seen between the duration of breastfeeding or age at introduction to complementary foods and prevention of asthma, wheeze, ARC and eczema.Trial registrationThe trial is registered in Current Controlled Trials as ISRCTN28090297.

Family-centered lactation counseling and breastfeeding in preterm infants upon neonatal intensive care discharge

Background: There is great variability in breastfeeding implications upon neonatal intensive care unit discharge for preterm infants. Aims and Objectives: To examine the breastfeeding rates and the impact of lactation-counseling on the nutrition following hospital discharge in preterm infants. Materials and Methods: A three-page survey was applied to the families of infants of gestational age ≤34 weeks who were hospitalized between 2016-2018. Exclusion criteria were family reluctance to consent, foster-care placement, acquiring enteral feeding by orogastric tube/gastrostomy. The group categorization was based on lactation-counselling that involved both parents and elderly relatives who would assist the mother at neonatal care. Statistics were performed using SPSS-22 for covariates of neonatal intensive care interventions and post-discharge nutrition. Results: Exclusive breastfeeding was 49.2% at hospital-discharge and declined to 31.3% at six months. Early introduction of complementary foods was 51.1%. Total duration of breastfeeding was 7.38±3.98 months. Lactation-counseling prolonged breastfeeding duration to 8.47±3.87 months. The program presented the highest odds of extending breastfeeding interventions beyond six months (OR: 2.183, 95% CI: 1.354–3.520). It favored the outcomes by reducing the introduction of formulas and complementary foods before six months (P = 0.044, P = 0.018). The physical contribution of the father towards nutrition was the most significant benefit claimed by the participants. (71.6 versus 51.8%). Conclusion: Family-centered peer lactation-counseling by the medical staff and increasing awareness for infant nutrition are promising local strategies in reaching the goals of national nutrition policies guided by the international recommendations in preterm infants.

Зависимость здоровья детей раннего возраста, поступающих в детское дошкольное учреждение, от социального статуса семей

Objective. To evaluate the health status of young children entering preschool institutions depending on the social status of their families. Patients and methods. This study included 375 children aged 2 to 3 years attending kindergarten No. 239 in Kemerovo. Mean age of children was 25.91 ± 2.52 months. All study participants were divided into several groups according to their social status: from two-parent families (TPF; n = 339), including those with registered marriage (RM; n = 258) and unregistered marriage (UM; n = 81), and from single-parent families (SPF; n = 36), including those living with divorced mothers (DM; n = 25) and single mothers (SM; n = 11). Results. Women living with their partners outside marriage had significant changes during their pregnancy, at the time of breastfeeding and introduction of complementary foods; every fourth woman smoked. Every third child from two-parent families with an unregistered marriage had group III health (p = 0.0298). Vegetative complaints were significantly more common in families with divorced parents and unregistered marriage. Conclusion. Measures to promote healthy marriage and family relations should be implemented by teachers and psychologists at schools, other organizations for children and adolescents, specialized secondary and higher educational institutions. Key words: infants, health, single-parent family, two-parent family, social status

Household Food Security, Child Dietary Diversity and Copping Strategies Among Rural Households. The Case of Kole District in Northern Uganda

Household food security, feeding practices, dietary diversity and copping strategies to household food insecurity are largely interconnected. Using a cross sectional study approach involving 162 mothers and care givers in Kole district of Northern Uganda, this study examined the scenarios of household food security status, child feeding practices, dietary diversity and copping strategies. The study revealed that majority of the households (55%) were food secure with an overall observation of low dietary diversity at the household level (72.8%), largely showing dominance of starch-based Cereals, roots and tubers (82%) and limited consumption of other food groups, notably fruits, vegetables, meats and dairy products (18% combined). In terms of feeding practices, majority of the children were fed breast milk for at least 24 months, with mandatory exclusive breastfeeding highly adhered to, but the introduction of complementary foods often delayed and not well planned. Results also showed that a wide range of coping strategies are employed however the major ones were, reliance on less preferred food (54.9%), limiting portions of meals (35.2%), reducing number of melas taken in a day (29%), and gathering wild fruits and harvesting immature crops (29.6%). Generally, it was observed that household food security is a strong determinant of dietary of child dietary diversity, may influence feeding practices and the range of coping strategies applicable to households when they experience food insecurity. It is apparent that nutritional education, household size and livelihood diversity also play a significant role in as far as household food security status, child feeding, diversity and food insecurity copping are concerned within rural households.

Принципы введения прикорма при атопическом дерматите

Atopic dermatitis (AD) is one of the most common inflammatory skin disorders. In most patients, AD is a starting point for developing other atopic diseases, e.g., food allergy, allergic diseases of the gastrointestinal tract, allergic rhinitis, and asthma known under the umbrella of "atopic march". In addition to genetic predisposition, various environmental factors are essential for the development of this dermatosis. In young children, food is the most relevant factor. This paper discusses principles of the selection of complementary food, techniques, and terms of its introduction. Prolonging of breastfeeding, the adequate introduction of complementary food, and personified nutrition program prevent the atopic march. The authors highlight that there is no special diet for atopic dermatitis. Meanwhile, food should be safe, low allergy, and balanced to provide a child with essential macro-and micronutrients. In addition, the paper addresses the utility and validity of an elimination diet which should be prescribed only in established food sensitization and used under the control o f a specialist. KEYWORDS: atopic dermatitis, atopic march, infancy, early childhood, nutrition, complementary foods, prevention. FOR CITATION: Botkina A.S., Dubrovskaya M.I. Principles of complementary food introduction in atopic dermatitis. Russian Medical Inquiry. 2021;5(6):421–426 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-421-426.

Factors influencing complementary feeding practices in rural and semi-urban Rwanda: a qualitative study.

The aim of the present study was to identify and describe the factors influencing feeding practices of children aged 6-23 months in Rwanda. This is a cross-sectional descriptive qualitative study. A total of ten focus group discussions were conducted separately with mothers, fathers, grandmothers and community health workers (CHWs) from five different districts in Rwanda. The discussions were recorded, transcribed verbatim, and thematically analysed using qualitative data analysis software, Atlas.ti. The study participants were mothers, fathers and grandmothers of children aged 6-23 months and CHWs in charge of child health. Caregivers' knowledge and beliefs about the benefits of breast-feeding and timely introduction of complementary food were found to be the primary individual factors facilitating good infant and young child feeding practices. The common belief of caregivers that infants should be given liquids (thin gruel, fruit juices and meat broth) as first foods instead of semi-solid foods was a barrier to good feeding practices. The community-based nutrition education and counselling programmes were facilitators of good complementary practices at the group level. At the society level, poverty in rural agrarian households was a barrier to optimal feeding practices. The study shows that there is a need to empower caregivers with more specific guidelines, especially on complementary feeding.

Longitudinal associations of modifiable risk factors in the first 1000 days with weight status and metabolic risk in early adolescence

Many studies have identified early-life risk factors for childhood overweight/obesity (OwOb), but few have evaluated how they combine to influence later cardiometabolic health. We aimed to examine the association of risk factors in the first 1000 d with adiposity and cardiometabolic risk in early adolescence. We studied 1038 mother-child pairs in Project Viva. We chose 6 modifiable early-life risk factors previously associated with child adiposity or metabolic health in the cohort: smoking during pregnancy (yes compared with no); gestational weight gain (excessive compared with nonexcessive); sugar-sweetened beverage consumption during pregnancy (≥0.5 compared with <0.5 servings/d); breastfeeding duration (<12 compared with ≥12 mo); timing of complementary food introduction (<4 compared with ≥4 mo); and infant sleep duration (<12 compared with ≥12 h/d). We computed risk factor scores by calculating the cumulative number of risk factors for each child. In early adolescence (median: 13.1 y) we measured indicators of adiposity [BMI, fat mass index (FMI), trunk fat mass index (TFMI)]. We also calculated OwOb prevalence and metabolic syndrome (MetS) risk z score of adolescents. Among 1038 adolescents, 71% had >1 early-life risk factor. In covariate-adjusted models, we observed positive monotonic increases in BMI, FMI, TFMI, and MetS z scores with increasing risk factor score. Children with 5‒6 risk factors (compared with 0-1 risk factors) had the highest risk of OwOb [risk ratio (RR): 2.53; 95% CI: 1.63, 3.91] and being in the highest MetS quartile (RR: 2.46; 95% CI: 1.43, 4.21). The predicted probability of OwOb in adolescence varied from 9.4% (favorable levels for all factors) to 63.6% (adverse levels for all factors), and for being in the highest MetS quartile from 9.6% to 56.6%. Early-life risk factors in the first 1000 d cumulatively predicted higher adiposity and cardiometabolic risk in early adolescence. Intervention strategies to prevent later obesity and cardiometabolic risk may be more effective if they concurrently target multiple modifiable factors.

Introduction of complementary foods to infant diet using baby-led weaning

Baby-led weaning (BLW) is an increasingly widely known method of introducing complementary foods to an infant’s diet. BLW is based on a child’s physical readiness for self-feeding, with a positive effect of expansion of a diet that was previously based exclusively on mother’s milk or formula milk. There are both advantages and disadvantages of BLW. The advantages of BLW include, among other aspects, the fact that the child finds eating pleasurable, it can eat meals together with the family, it can eat away from home and has an opportunity to learn new flavours. The disadvantages of BLW include, for example, disorder caused by the child during self-feeding and a risk of choking. In order to prevent choking, it is recommended that products which are small and round with a hard and smooth surface, and a cross-section resembling that of the child’s airways be avoided. According to the current guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, for the first 6 months of life a child should be fed exclusively with their mother’s milk and complementary foods should be introduced starting between week 17 and 26 of the child’s life due to the development of readiness to consume solid food. Complementary feeding can be achieved through self-feeding based on BLW or by the child being fed by an adult using a spoon, among other means. The order in which different products are introduced is decided on by the parents. After the child has turned one year of age, breastfeeding should be continued as long as the mother and child wish.

Factors Affecting Complementary Feeding of Infants. A Pilot Study Conducted after the Introduction of New Infant Feeding Guidelines in Poland.

Adequate nutrition in the first year of life is the key prerequisite for a child’s healthy growth and development. The success of complementary feeding is influenced by various factors, including the family’s socioeconomic status, maternal age, place of residence and educational level, older children and duration of breastfeeding. Modified infant feeding guidelines were introduced in Poland in 2016. The aim of this study was to identify the factors that exert the greatest influence on infant feeding practices in the Polish population. A thorough understanding of maternal factors that are responsible for undesirable feeding practices is required to improve the mothers’ knowledge and to promote healthy feeding practices. This study was carried out in March–June 2018 and between November 2018 and March 2019 in the Region of Lublin in southeastern Poland. The mothers of children aged 9–14 months, who had introduced complementary foods, were invited to the study. A total of 441 mothers agreed to participate, and 289 of them fully and correctly completed the questionnaires. Logistic regression models were developed to assess the association between maternal factors, such as age, educational level and the nutrition knowledge score, and introduction of solid foods. The infant’s sex and birth weight and the mother’s place of residence had no significant influence on the duration of breastfeeding. The mother’s age and educational level, the number of children in the family and maternal nutrition knowledge scores contributed to significant differences in breastfeeding duration. Older mothers (30–34 years vs. 25–29 years, p = 0.001), better educated mothers (university vs. secondary school education p = 0.002) and mothers with one or two children exclusively breastfed their children for longer (17 weeks vs. 11 weeks, p = 0.002) than younger mothers with secondary school education and more than three children. Exclusive formula feeding was significantly correlated with untimely introduction of solid foods compared to exclusive breastfeeding (13 weeks vs. 19.7 weeks, p = 0.001). Mothers with nutrition knowledge scores in the upper tertile were more likely to adapt food consistency to the skills manifested by the child (88%) (OR = 1.88; Cl: 1.53–2.26, p < 0.05) and were less likely to delay the introduction of new foods that required chewing and biting (84%) (OR = 0.22; Cl: 0.09–0.34, p < 0.05) than mothers with nutrition knowledge scores in the bottom tertile. Maternal age, educational level and nutrition knowledge significantly increased the age at which infants were introduced to solid foods and the correct identification of the signs indicative of the child’s readiness to explore new tastes and foods with a new consistency. The above factors contributed to delayed, but not untimely, introduction of complementary foods (6 months of age or later), including gluten.

Characterization of Infant Feeding Practices and Related-Family Characteristics in the French Nationwide ELFE Birth Cohort.

Family characteristics such as education level or income are related to infant feeding practices. This study aimed to characterize infant feeding practices and investigate their associations with family characteristics. Analyses were performed with data from a French nationwide cohort, Etude Longitudinale Française depuis l’Enfance (ELFE). Feeding practices were characterized by two methods, a principal component analysis and a hierarchical ascendant classification (n = 8922). This characterization was conducted in three steps: considering firstly only introduction of main food groups, then also food pieces and finally adding the type of complementary food. The associations between family characteristics and the infant feeding patterns or clusters were tested by linear or multinomial regressions (n = 7556). Besides breastfeeding duration and age of first introduction of complementary foods, it appeared also important to consider specific food groups such as sweetened beverages and cow’s milk, and the introduction of food pieces, to describe feeding practices. Recommended feeding practices (longer breastfeeding, complementary food in the right period) were related to higher maternal age and education level, so was migration status, the presence of older children, low income or the mothers’ attendance to pre-birth preparation classes. The interrelations between feeding practices and family characteristics must be considered when examining the influence of feeding practices on child’s health.

Prevalence of Iron Deficiency in Infants of Diabetic Mothers at the Age of 6 to 12 Months

Background: Iron deficiency (ID) and iron deficiency anemia (IDA) are worldwide problems in infants. The infants of diabetic mothers (IDMs) usually have low iron storage at birth. Therefore, they are at risk for developing ID and IDA during late infancy. Objective: To determine the prevalence of ID and IDA in IDMs aged 6 to 12 months and to identify the risk factors associated with abnormal iron status. Materials and Methods: The present study was a prospective descriptive study conducted in healthy, full-term, IDMs between the ages of 6 to 12 months. Growth and dietary history of IDMs as well as maternal history of diabetes were evaluated. Anemia and iron status were determined by hemoglobin, serum ferritin, and transferrin saturation. Results: Of the 50 IDMs, the prevalence of ID was 46%, and iron depletion was 14%. IDA was found in 11 IDMs. Although the gender, gestational age, birthweight, and the age of complementary food introduction were not found to be associated with abnormal iron status, infants with ID and iron depletion were more likely to be breastfed, or breastfed longer than six months, when compared to iron sufficient infants (p&lt;0.001). No exclusively breastfed infants had iron sufficiency in the study. Conclusion: There was a high prevalence of ID and IDA in IDMs. Therefore, screening for iron status along with anemia is crucial in IDMs at an earlier age. Moreover, iron supplementation starting at four months should be considered in IDMs who were exclusively or mainly breastfed. Keywords: Anemia, Iron deficiency, Iron deficiency anemia, Infants of diabetes mothers

Complementary Food Introduction: Practitioner Variation

Complementary Food Introduction: Practitioner Variation

Timing of Introduction of Complementary Foods - United States, 2016-2018.

The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,927) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 31.9% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that many infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.

Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children

Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population. To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum. This study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted. The 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons. Primary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs). A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, -0.67; 95% CI, -0.04 to -1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, -0.54; 95% CI, -0.94 to -0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, -0.46; 95% CI, -0.92 to 0.01). Infants of Native American mothers who participated in a home-visiting intervention had substantially lower SSB consumption and improvements in responsive feeding practices and infant zBMI scores, suggesting the intervention is effective for promoting healthy infant feeding and growth. ClinicalTrials.gov Identifier: NCT03101943.

Effect of complementary feeding behavior change communication delivered through community-level actors on the time of initiation of complementary foods in rural communities of West Gojjam zone, Northwest Ethiopia: a cluster-randomized controlled trial

BackgroundAttaining the recommended level of complementary feeding practices remains a serious challenge in many developing countries. Complementary foods are usually untimely initiated, which has adverse consequences on the growth, development, and survival of infants. The focus of most studies conducted worldwide seemed to be on the effect of behavior change interventions on the adequacy of complementary diets; but not on the timing of initiations. Moreover, many of the interventions targeted only mothers/caregivers of infants, and studies that engaged the family members are scarce. This study aimed to evaluate the effectiveness of complementary feeding behavior change communication delivered through women development army leaderson the time of initiation of complementary foods.MethodsWe conducted a cluster-randomized controlled trial in rural communities of West Gojjam Zone, Northwest Ethiopia from February 2017 to March 2018. A total of 16 geographic clusters were selected. Trial participants in the intervention group received complementary feeding behavior change intervention for 9 months whereas those in the control group received only the usual health care. Trained women development army leaders delivered the intervention. A pre-tested, structured interviewer-administered questionnaire was used for data collection. Generalized estimated equation (GEE) regression and survival analyses were used to test differences in time of initiation of complementary food between the study groups.ResultsThe intervention significantly improved the likelihood of timely initiation of complementary food by 22 percentage points [RR: 2.6; 95% CI: 1.78–5.86], and reduced the risk of late initiations by 19 percentage points [RR: 2.8; 95% CI: 1.83–4.37]. The complementary food initiation survival curve for the control group after 6 months was constantly above the curve than for the intervention group. The median age at the introduction of complementary food for infants was 6 months in the intervention group, and 6.7 months in the control group and the difference was statistically significant (P-value < 0.001).ConclusionsComplementary feeding behavior change communication improved the rate of timely initiation of complementary foods and reduced the risk of late initiations.Trial registrationClinicalTrials.gov, NCT03488680. Registered 5 April 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03488680.