Complementary Food Consumption Research Articles

Dietary Exposure of Infants and Young Children to Aflatoxins and Fumonisins in the East African Region: A Review

Proper supplementary nutrition is essential for nurturing and promoting the growth and development of Infants and Young Children (IYC). Poor food quality and safety during this critical period can result in malnutrition. Complementary foods (CF) commonly provided to IYC in East African countries often contain ingredients highly susceptible to mycotoxin contamination, particularly aflatoxins (AFs) and fumonisins (FBs). This narrative review sought to explore the contamination of infant diets with AFs and FBs, as well as the exposure of IYC to these toxins. The review covers the types of CF used in infant diets, their susceptibility to AFs and FBs contamination, associated dietary exposure, and detection methods, along with regulatory and mitigation strategies in the East Africa region. Studies revealed widespread contamination of staple crops with AFs and FBs, highlighting that IYC primarily encounter these toxins through the consumption of cereal-based CF, often supplemented with legumes and oily seeds. Maize and groundnuts emerge as the predominant ingredients in CF. Despite established regulatory limits for these toxins in food intended for the general population, no specific limits exist for IYC, who are particularly vulnerable due to their high consumption of the susceptible crops and relatively small body size. Limited enforcement of existing regulations, unfortunately, allows the problem to persist in these low-resource countries. Focusing on East Africa, this review synthesizes findings from scientific studies to assess the dietary exposure of children to AFs and FBs through CFs. The findings underscore the need for further research on the magnitude and effects of AFs and FBs exposure, coupled with awareness campaigns to promote the demand for clean and safe CF within the East African Community countries.

Lactobacillus-derived indole derivatives ameliorate intestinal barrier damage in rat pups with complementary food administration.

The consumption of complementary foods can bring about diarrhea and intestinal barrier dysfunction in infants. In this study, three different Lactobacillus strains combined with L-tryptophan (Trp) were administered to rat pups with complementary foods. Complementary food feeding caused inflammatory cell infiltration, crypt structure irregularity and goblet cell reduction in the colon tissues of the rat pups. However, the oral administration of Trp combined with Lactiplantibacillus plantarum DPUL-S164 or Limosilactobacillus reuteri DPUL-M94 significantly restored the pathological changes in the colon tissues and inhibited the expression of pro-inflammatory cytokines in the colon and ileum of the rat pups. M94 or S164 combined with Trp intervention could promote the expression of cell differentiation genes and tight junction proteins, and restore the intestinal barrier damage caused by complementary foods in rat pups by activating the aryl hydrocarbon receptors (AhR) and nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. In addition, the indole-3-lactic acid (ILA), indole-3-propionic acid (IPA), or indole-3-carbaldehyde (I3C) level in the cecal contents of the rat pups increased after intervention of Trp combined with S164 or M94, which may account for the amelioration of intestinal barrier damage in rat pups administered with complementary foods. Furthermore, S164 or M94 combined with Trp intervention up-regulated the relative abundance of f_Lactobacillaceae, f_Akkermansiaceae, g_Lactobacillus, and g_Akkermansia in the intestinal tract of the rat pups. In conclusion, S164 or M94 combined with Trp intervention can ameliorate complementary food-induced intestinal barrier damage and gut flora disorder in rat pups by producing ILA, IPA, or I3C, which are AhR ligands.

Predictors of milk cortisol in North American women.

Human milk content varies across mother-child dyads, environments, and populations. Among the hormones in milk is cortisol, a glucocorticoid; its impact on the breastfeeding child is unknown. Milk cortisol may constitute a signal to the child's developing physiology which can shape characteristics (e.g., growth, temperament) to prevailing environmental conditions. This exploratory study evaluated the maternal, breastfeeding, and infant characteristics associated with milk cortisol. We evaluated archived milk specimens for cortisol using enzyme immunoassay and employed an information-theoretic approach to assess associations between milk cortisol and participant characteristics with linear regression modeling. Because we employed secondary data, information for some variables likely to impact milk cortisol variation (e.g., time of day, socioeconomic status, maternal or infant body mass index, milk energy density) was unavailable. Participants were 48 lactating mothers from upstate New York, aged 21-40 years. Milk cortisol ranged from 0.098 to 1.007 μg/dL. Child age ranged from 1 to 26 months. In linear regression employing best fit modeling criteria, milk cortisol increased with child age (B: 0.069; p: .000; a 7.1% increase in milk cortisol for each month of child age), while child symptoms of illness (B: -0.398; p: .057; a 33% decrease) and consumption of complementary foods (B: -.525; p: .020; a 41% decrease) were associated with lower milk cortisol. We speculate that increasing milk cortisol with child age plays a role in signaling development (e.g., as increasing independence increases risk for injury and other negative health outcomes), independent of the maternal stressors we could capture.

Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence.

Suboptimal complementary feeding practices remain highly prevent. This review aims to comprehensively synthesize new emerging evidence on a set of topics related to the selection and consumption of complementary foods. We synthesized evidence related to five key topics focused on nutritional interventions that target the complementary feeding period, based on four systematic reviews that include updated evidence to February 2022. While there have been many studies examining interventions during the complementary feeding period, there is an overall lack of relevant information through which to draw conclusions on the ideal feeding schedule by food type. Similarly, few studies have examined the effects of animal milk versus infant formula for non-breastfed infants (6-11 months), though those that did found a greater risk of anemia among infants who were provided cow's milk. This review highlights a number of interventions that are successful at improving micronutrient status and anthropometry during the complementary feeding period, including fortified blended foods, locally and commercially produced supplementary foods, and small-quantity lipid-based nutrient supplements. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food secure and insecure populations.

Evaluation of nutritional quality of complementary foods formulated from blends of Nigerian yellow maize (Zea mays), soybean (Glycine max) and crayfish (Procambarus clarkii).

Plant-based complementary foods (CFs) supply insufficient amount of nutrients to meet recommended nutrient intakes for 6-23-month-old children. The present study determined the nutritional quality of CFs formulated from blends of Nigerian yellow maize (Zea mays), soybean (Glycine max) and crayfish (Procambarus clarkii). Three CFs were formulated; namely, maize flour (MF, 100:0% w/w), blends of maize and soybean flour (MSF, 72:28% w/w), and maize, soybean and crayfish flour (MSCF, 80:10:10% w/w). Nutritional quality was evaluated using analyses of chemical composition of CFs and of protein quality of complementary food diets. Data were compared by multivariate analysis of variance and significantly differentiated. Nine selected nutritional criteria were used to decide the CF that had best nutritional characteristics compared to MF and fortified wheat flour (FWMF). Total scores obtained from the selected nutritional criteria ranked MSCF, with total score of 15, as the lowest and thus it was considered to have the most desirable nutritional characteristics compared to MF, MSF and FWMF, which had respective total scores of 31, 22 and 20. Conclusively, MSCF may serve as a better alternative CF for MF, MSC and FWMF. The present study has produced a potential alternative cost-effective and adequate CF, formulated from crayfish (P.clarkii) supplementation of locally available blend of yellow maize (Z.mays) and soybean (G.max), for the poor human population, aiming to encourage the consumption of animal-sourced CF for alleviating the prevalence of childhood undernutrition. © 2022 Society of Chemical Industry.

Organic Food Consumption During the Complementary Feeding Period and Respiratory or Allergic Diseases Up to Age 5.5 Years in the ELFE Cohort.

Objectives: To assess (1) whether a history of allergy is associated with feeding with organic foods (OFs) during the complementary feeding period and (2) whether OF consumption in infancy is related to the incidence of respiratory and allergic diseases up to age 5.5 years.Study Design: Analyses involved more than 8,000 children from the nationwide Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort. Associations between family or infant history of allergy and frequency of OF consumption during the complementary feeding period were assessed with multinomial logistic regression. Associations between OF consumption in infancy and respiratory or allergic diseases between age 1 and 5.5 years were assessed with logistic regression.Results: A family history of allergy or cow's milk protein allergy at age 2 months was strongly and positively related to feeding with OF during the complementary feeding period. Feeding with OF during the complementary feeding period was not related to respiratory diseases or eczema up to age 5.5 years. Compared to infrequent consumption of both organic and commercial complementary foods, frequent OF consumption without commercial complementary foods was associated with a higher risk of food allergy, whereas frequent commercial complementary food consumption without OF use was associated with a lower risk of food allergy.Conclusions: This study suggests that a history of allergy strongly affects feeding with OF during the complementary feeding period. However, OF consumption was not associated with reduced odds of food allergy later in childhood but could be associated with increased odds, which should be examined more deeply.

Food diversity among indigenous children from two municipalities of the Brazilian Western Amazon.

Our aim was to explore the feeding practices of indigenous children younger than two years old, living in Cruzeiro do Sul and Mâncio Lima, in Acre, Brazil. A cross-sectional study was conducted with indigenous children of the Katukina (Cruzeiro do Sul), Nukini, Nawa and Poyanawa (Mâncio Lima) ethnicities in October 2013. We used a structured questionnaire on the food consumption of the day before the collection, based on the food indicators proposed by the Ministry of Health. A total of 94 children (50% Katukina, 27% Poyanawa, 13% Nukini, and 10% Nawa) were studied. Among children under 6 months of age, although the majority was breastfed, 42.1% drank water, 15.8%, savory food, and 11.1%, local cuisine. In the age groups of 6 to 12 months and 13 to 23 months, a high consumption of ultra-processed foods was identified (52.6% and 28.6% respectively), while the consumption of complementary food was insufficient (33% of fruits and 25% of savory food between 6 and 13 months, and 41.2% of fruits and 19.6% of savory food between 13 and 23 months). The feeding profile of these indigenous children was inadequate for their age, revealing a concerning situation for this population.

Total arsenic in complementary food and its exposure assessment for children aged 6–24 months

We report arsenic in complementary food (CF) and its exposure in children aged 6–24 months in Indonesia. The food consumption survey used the 24-h food recall method towards 385 respondents aged 6–24 months in Jakarta followed by food analysis using AAS with hydride vapor generator to determine the exposure and risk of total arsenic (t-As) in CF. The determination method of t-As in CF was verified for validity. Cereals and cereal products were the dominant CF food group consumed by children aged 6–24 months. The mean and 95th percentile (P95) of CF consumption from the food group were at 23.69 and 58.73 g/kgBW/day. All samples had a positive of t-As ranging from 0.32 ± 0.09 ng/g to 452.51 ± 200.41 ng/g. CF from fish and fish products had the highest t-As level. The mean and P95 of total exposure to t-As in CF from all food groups were 2.99 and 10.74 μg/kgBW/day for children aged 6–24 months. The risk of t-As reached 140% (mean) and 502% (P95) of TDI (derived from PTWI), which is a significant risk to health. CF from cereals and cereal products had the highest contribution to the risk.

Early consumption of ultra-processed foods among children under 2 years old in Brazil.

To evaluate the complementary food consumption according to the extent and purpose of food processing based on NOVA classification among children aged 6-24 months of Federal District, Brazil. We performed a cross-sectional study using a 24-h recall to estimate the daily energy intake and nutrients according to NOVA classification. We conducted a linear regression to assess the association between the processed and ultra-processed foods (UPF) energy intake and the daily energy intake from saturated fat, daily energy intake from total sugars and daily intake of sodium. Federal District, Brazil. Five hundred and thirty-eight children aged between 6 and 24 months attended at Primary Health Care Units from March 2017 to March 2018. On average, children aged from 6 to 12 and from 12 to 24 months consumed 2393 and 4054 kJ/d, respectively, and processed and UPF represented one-third of dietary energy intake. Group 2 (processed and UPF) was higher carbohydrate contributors, and lower protein, fibre and most micronutrient contributors, when compared with Group 1 (unprocessed, minimally processed foods and processed culinary ingredients). In addition, the higher the energy intake from processed and UPF, the higher was the daily energy intake from saturated fat, daily energy intake from total sugar and daily intake of sodium. Children are being exposed early to processed and UPF and their share affect the diet's nutritional quality.

Perbedaan status gizi bayi usia 6-9 bulan yang diberi MPASI buatan pabrik dan rumah

The differences of nutritional status of 6-9 months old infant given factory-made and homemade complementary foodsBackground: The nutritional status of 6-9 months old babies depend on the amount of nutrition acquired from breastmilk and complementary food. The incorrect feeding of complementary food may contribute to poor nutritional status. Objective: This study aims to illustrate the nutritional status of factory-made and homemade complementary food, and analyze the difference in the nutritional status of infants given factory-made and homemade complementary food.Methods: This is an analytic, observational, and cross-sectional study, conducted in seven villages within the scope of Puskesmas Jatinangor, Jatinangor Sub-district, Sumedang Regency in August-October 2018. The samples were 102 babies 6-9 months old obtained through total sampling. The variables of this study include the type of complementary food, and infant nutritional status with weight for age, length for age, and weight for height index.Results: Complementary food consumption is dominated by factory-made type (69.6%). Macronutrients which are energy and protein and micronutrients which are vitamins from both types of complementary food already fulfill the daily recommended dietary allowances for babies, except for minerals which are calcium, iron, and zinc. Chi-Square test results showed an insignificant difference in the nutritional status of babies (p=0,881 for BW/A; p=0.194 for BH/A; and p=0,599 for BW/BH) based on the type of complementary food given.Conclusions: Nutritional contents of macro and micronutrients from both types of complementary food have fulfilled the recommended dietary allowances for complementary food, except for the minerals calcium, iron, and zinc. There wasn’t a considerable difference in nutritional status between those acquired through factory-made and homemade complementary food.

Assessing the mycotoxicological risk from consumption of complementary foods by infants and young children in Nigeria

This study assessed, for the first time, the mycotoxicological risks from consumption of complementary foods by infants and young children in Nigeria. Molds belonging to Aspergillus aculeatinus, A. flavus, A. luchuensis, A. tubingensis, A. welwitschiae and Geotrichum candidum were recovered from the complementary foods. Twenty-eight major mycotoxins and derivatives, and another 109 microbial metabolites including chloramphenicol (a bacterial metabolite), were quantified in 137 food samples by LC-MS/MS. Aflatoxins and fumonisins co-contaminated 42% of the cereal- and nut-based food samples, at mean concentrations exceeding the EU limits of 0.1 and 200 μg/kg set for processed baby foods by 300 and six times, respectively. Milk contained mainly beauvericin, chloramphenicol and zearalenone. The trichothecenes, T-2 and HT-2 toxins, were quantified only in infant formula and at levels three times above the EU indicative level of 15 μg/kg for baby food. Chronic exposure estimate to carcinogenic aflatoxin was high causing low margin of exposure (MOE). Exposures to other mycotoxins either exceeded the established reference values by several fold or revealed low MOEs, pointing to important health risks in this highly vulnerable population. The observed mycotoxin mixtures may further increase risks of adverse health outcomes of exposure; this warrants urgent advocacy and regulatory interventions.

Formative research to explore the acceptability and use of infant food grinders for the promotion of animal source foods and micronutrient powders in rural Peru.

According to global recommendations, quality diets for complementary feeding (CF) should include a diversity of foods including vitamin A-rich fruits and vegetables and sources of high-quality proteins and essential nutrients, particularly animal-source foods (ASF). A key barrier to feeding ASF surrounds beliefs that the preparation of foods of a thicker consistency may cause problems of digestion, "heaviness" or stomach problems, swallowing, and choking. The objective of this study was to explore, through systematic formative research, the acceptability, use, and feasibility of a simple technology, commercial infant food grinders, in two rural Peruvian settings where there is delayed and low consumption of complementary foods of a thick consistency, including ASF. Phase I explored the barriers, constraints, and opportunities related to the provision of foods of a thicker consistency with a focus on ASF. Phase II encompassed household behavioural trials with mothers and infants to assess the acceptability and use of the grinders in the home setting, using key concepts and messages developed from the information obtained during Phase I. The technology was highly acceptable, used by the majority of mothers (87.8%), and led to changes in cultural perceptions, facilitating increased feeding of appropriate textures (thick purees), ASF, and multimicronutrient powders. Energy, protein, and micronutrient intakes were all significantly greater after the household behavioural trials. This simple technology, paired with systematic formative research to appropriately promote its use across cultures, may have a significant effect on improving CF practices globally, particularly for young infants beginning CF at 6months.

Boys Are More Stunted than Girls from Early Infancy to 3 Years of Age in Rural Senegal

Background: Girls tend to have a lower risk of stunting than boys do in low-income countries.Objective: We evaluated differences in height status and complementary food (CF) intake between sexes from ages 2 to 39 mo in Senegal.Methods: Length and weight measurements were taken at ages 2-3, 4-5, 6-8, and 9-10 mo (n = 7319). Qualitative 24-h and 7-d food recalls were conducted in a subgroup (n = 2512). A smaller subsample was followed up to age 39 mo (n = 512). Height was measured, and intake of CF was noted. Boys and girls were compared in terms of height-for-age z score (HAZ) of WHO standards and National Center for Health Statistics growth reference, height-for-age difference, stunting, and consumption of CF by using chi-square tests, general linear models, and mixed-effects linear models (MLMs).Results: By using WHO standards, the mean HAZ was lower for boys than for girls in infancy, i.e., at 2-3 mo of age (-0.65 compared with -0.57; P = 0.002) and beyond, i.e., at 24-29 mo of age (-2.01 compared with -1.65; P < 0.001). Overall risk of stunting was 24.5% and 19.4% for boys and girls, respectively, during infancy (P < 0.001) compared with 59.2% and 47.9%, respectively, at 12-39 mo (P = 0.010). In MLMs from ages 2 to 39 mo, boys had a lower mean HAZ than girls had at age 2 mo (β0 = -0.19; P = 0.035), and sex differences increased with increasing age (β1 = -0.007 z scores/mo; P < 0.001). At 2-3 mo of age, boys were more likely to have been fed CF every day during the past week (15.8% compared with 11.2% for girls; P = 0.005) and to have eaten ≥2 meals in the past 24 h (13.4% compared with 8.2% for girls; P < 0.001).Conclusions: In Senegalese infants, CF intake differed by sex, with boys more likely to consume CF. Boys had lower HAZs than girls had during infancy, and sex differences increased up to age 39 mo. The importance of sex in complementary feeding and growth warrants further attention in low-income countries.

Patterns of Growth in Early Childhood and Infectious Disease and Nutritional Determinants.

The physical growth of young children in low- and middle-income countries is reduced compared to international standards. The deviations in growth in both weight and height are greatest in the first 2 years of life and this has serious consequences for child mortality, development, adult stature, and health. The determinants of these patterns of growth faltering include intergenerational factors, such as maternal height, short birth interval, and conditions in pregnancy, including maternal underweight and anemia. These factors contribute to fetal growth restriction and premature delivery, which put many infants on a different growth trajectory. Postnatal exposure to microbes resulting in diarrhea and febrile infectious diseases and poor quality diet further compromise growth. Determinants of growth faltering after birth vary by setting and are not independent of each other. For example, the adverse effects of diarrhea on growth may be mitigated by a high-quality diet. Global estimates suggest that 25% of stunting can be attributed to fetal growth restriction and even more in countries in South Asia with a high prevalence of low birth weight. Infectious diseases may contribute a similar amount and subclinical enteric infections can result in intestinal dysfunction with adverse effects on nutrition and growth. Dietary factors, especially consumption of complementary foods of insufficient quality, have a paramount role in growth faltering in the critical period of infancy.

Commercial complementary food consumption is prospectively associated with added sugar intake in childhood.

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

ASUPAN ZAT BESI DAN SENG PADA BAYI UMUR 6 – 11 BULAN DI KELURAHAN JATI CEMPAKA, KOTA BEKASI, TAHUN 2014

Infants are at higher risk of iron and zinc deficiency because of their rapid growth and higher iron and zinc needs. The infants’ iron and zinc status are directly affected by their dietary intake. The aims of this study were to measure the average and the deficit of iron and zinc intake in infants aged 6 – 11.months in Kelurahan Jati Cempaka Kota Bekasi, 2014. The research was conducted in 10 Integrated Health Service in Kelurahan Jati Cempaka, Bekasi City, 2014. Eighty pairs of infants and mothers were selected as samples. Infants’ intake were assessed by 2 x 24 hours non-consecutive dietary recall. Independent T test analysis were conducted to identify the differences in iron and zinc intake between underweight infant and infant with normal nutritional status. Analysis showed that iron and zinc the total of average of breastfeeding infants were 2,3 ± 1,2 mg/day and 1,7 ± 0,7 mg/day. Iron and zinc The average deficit of of breastfeeding infants were 4,7 ± 1,2 mg/day and 1,3 ± 0,7 mg/day. There was significant difference on the average of iron intake between underweight infant and infants with normal nutritional status. But there was no significant difference on the zinc intake. However zinc intake the average of of underweight infant was lower than the normal infant with normal nutritional status. Nutrition counseling about good complementary feeding practice to the mothers of infants is needed, especially complementary food from animal source. Multi micro nutrient supplementations to the infants need to be considered, regarding low consumption of complementary food from animal source.

Critical Dietary Habits in Early Childhood: Principles and Practice.

The adequacy of a diet is usually evaluated based on nutrient intake. As people eat foods but not nutrients, food-based dietary guidelines (FBDG) are needed. To evaluate dietary habits in infants and young children, the following stepwise approach is suggested: (1) develop country-specific FBDG to identify the potential of common nonfortified foods to ensure adequate nutrient intake and (2) examine potential 'critical' dietary patterns if main food groups are excluded, such as in vegetarian diets or if a family's precarious social status leads to food constraints. The German FBDG for infant and child nutrition demonstrate that a well-designed mixture of common foods results in an adequate supply of nutrients, except for vitamin D, iodine and iron. The following solutions are feasible to address deficiencies in these critical nutrients: routine supplementation (vitamin D), fortified complementary food consumption or supplementation for infants as well as inclusion of table salt in the family diet for children (iodine), and individual pediatric care for infants at risk (iron). In the exclusion of food groups of animal origin from vegetarian diets, several nutrients are at risk of becoming deficient if not substituted. Existing studies characterizing vegetarian children are rare. These were mainly published in the 1980s and 1990s and were biased towards a high social status. Thus, firm conclusions on today's dietary practices and health statuses of European vegetarian children cannot be drawn. A social gradient exists for food patterns and dietary quality in children, but energy intake need not necessarily be affected. Scenarios in Germany suggest that families on unemployment assistance can afford to eat a diet compliant with German FBDG only if they restrict food selection to basic food. Yet, the question of how families cope with financial constraints in everyday life remains. In conclusion, well-designed FBDG provide various opportunities to identify critical nutrients and critical food habits in early childhood and beyond.

Associations between commercial complementary food consumption and fruit and vegetable intake in children. Results of the DONALD study

Objectives: Fruit and vegetable (FV) consumption is influenced by individual taste and food preferences that are developed early in life. Thus, the sensory properties of foods given during complementary feeding may shape later food acceptance and dietary intake. However, those experiences differ with respect to the preparation method of complementary food (CF), that is, homemade and commercial CF. The aim of this study therefore was to examine the association between the infant's consumption of commercial CF and FV intake and variety during infancy, preschool and school age. Methods: In total, 281 children of the DONALD Study with 3-day weighed dietary records at 0.5 and 0.75 (infancy), 3 and 4 (preschool age), 6 and 7 years of age (school age) were included in this analysis. Percentage of commercial CF (%cCF) was averaged at 0.5 and 0.75 years. Individual FV intake (g/day) and FV variety scores were calculated and averaged separately for all three age groups. Multivariate linear regression was used to analyse associations between %cCF and FV intake and variety. Models were adjusted for early life and socioeconomic factors. Results: For boys, higher %cCF was associated with lower vegetable intake in infancy (p < 0.0001) and preschool age (p = 0.036) as well as lower total FV intake in preschool and school age (p < 0.009). For girls, higher %cCF was associated with lower vegetable intake (p < 0.0001) in infancy. FV variety scores showed no clear associations with %cCF in girls and boys. Conclusion: The results of the DONALD Study suggest that the preparation method of CF is associated with FV consumption in infancy and at least for boys also in preschool and school age.

Breast‐Feeding and Weaning Practices in the DONALD Study

Besides influencing short- and long-term health status, infant feeding practices are known to have an effect on later food preferences. This study aimed to identify present trends in breast-feeding duration and weaning practices with special focus on preparation methods of complementary food (CF), that is, homemade and commercial CF. In total, 1419 three-day weighed diet records collected between 2004 and 2012 from 366 children of the German DOrtmund Nutritional and Anthropometric Longitudinally Designed study ages 6 to 24 months were analysed. Full (n = 339) and total breast-feeding duration (n = 344) was collected by questionnaire. To investigate age and time trends, logistic regression and polynomial mixed regression models were used. Infants born between 2008 and 2012 were 3.3-fold less likely to be fully breast-fed for ≥4 months than those born before 2004 (P < 0.0001). Overall, 59.3% commercial, 21.1% homemade, and 19.6% combined CF was consumed by the study sample. Subjects with high commercial CF consumption (percentage of commercial CF > median 62%) were significantly older (P < 0.0001), showed shorter full and total breast-feeding duration (P < 0.0001), and were more likely to have mothers with a lower educational status (P = 0.01). Both commercial and homemade CF showed opposing, nonlinear age trends. No time trends could be found. Decreasing duration of full breast-feeding should encourage health care providers to further promote longer breast-feeding duration. With the constantly high consumption of commercial CF at all ages, nutritional adequacy of both homemade and commercial CF needs to be investigated closer, as does their long-term influence on health and dietary habits, for example, fruit and vegetable intake.

MALNUTRITION IN CHILDREN UNDER FIVE IN IRAN

Background Children make a significant proportion of human population and their healthy growth and development ensure the future health of society. Childhood is considered as one of the most significant life stages for growth and health at other stages. Due to specific nutritional need, children are prone to food insufficiency. Accordingly, nutritional condition of children under 5 is an appropriate measure for evaluating the condition of health in a society. Purpose This study was intended to report malnutrition condition of Iranian children under 5 by reviewing related studies. Methods Different Iranian and international databases including Iran Medex, Irandoc and Pubmed were searched. Results Studies found that the prevalence of malnutrition in children under 5 was different at regions of the country and between 8.6% and 34%. The least amount (8.6%) was seen in Gilan province and the highest in Sistan and Baloochestan province. Risk factors in this regard were low-birth-weight, poor family planning, lack of consumption of complementary food, lack of mother’s knowledge regarding the proper time to start complementary nutrition and low level of mother’s education. Keywords: Malnutrition, Children under five, Nutritional state.