Early Introduction Of Complementary Foods Research Articles

Usual nutrient intakes of infants and toddlers in San Marcos, TX reflect regional differences in nutrition risk

Large, national studies demonstrate generally adequate nutrient intakes among infants and toddlers in the US; however, focused studies show certain racial, regional, and socioeconomic groups to be at increased risk for excessive or deficient intakes. The population of San Marcos, TX is primarily Hispanic, with a 50% incidence of overweight/obesity among middle school children. We collected feeding practice data and 24 h recalls using Nutrition Data System for Research for 203 infants and toddlers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children. We used the National Cancer Institute (NCI) method to estimate usual intake of nutrients, and to assess the impact of characteristics such as race/ethnicity, caregiver education, and early introduction of complementary foods on usual nutrient intake. Mean caloric intake exceeded DRI recommendations by 50% and 16% among infants 4–6 and 6–12 mo, respectively. Usual intake of zinc exceeded the UL in all age groups. Usual intake of vitamin E was less than the RDA in 85% of toddlers 12–24 mo. Usual intake of calcium was less than the RDA in 100% of toddlers 12–24 mo. Consumption of cereal before age four months was negatively correlated with usual intake of vitamin B12 (P<.05) and protein (P<.05). Our results indicate that studies of small, regional populations can reveal relevant nutritional issues that may be obscured in national studies.

Introduction of complementary foods in infancy and atopic sensitization at the age of 5 years: timing and food diversity in a Finnish birth cohort

To study the associations between timing and diversity of introduction of complementary foods during infancy and atopic sensitization in 5-year-old children. In the Finnish DIPP (type 1 diabetes prediction and prevention) birth cohort (n = 3781), data on the timing of infant feeding were collected up to the age of 2 years and serum IgE antibodies toward four food and four inhalant allergens measured at the age of 5 years. Logistic regression was used for the analyses. Median duration of exclusive and total breastfeeding was 1.4 (interquartile range: 0.2-3.5) and 7.0 (4.0-11.0) months, respectively. When all the foods were studied together and adjusted for confounders, short duration of breastfeeding decreased the risk of sensitization to birch allergen; introduction of oats <5.1 months and barley <5.5 months decreased the risk of sensitization to wheat and egg allergens, and oats additionally associated with milk, timothy grass, and birch allergens. Introduction of rye <7.0 months decreased the risk of sensitization to birch allergen. Introduction of fish <6 months and egg ≤11 months decreased the risk of sensitization to all the specific allergens studied. The introduction of <3 food items at 3 months was associated with sensitization to wheat, timothy grass, and birch allergens; the introduction of 1-2 food items at 4 months and ≤4 food items at 6 months was associated with all endpoints, but house dust mite. These results were particularly evident among high-risk children when the results were stratified by atopic history, indicating the potential for reverse causality. The introduction of complementary foods was consecutively done, and with respect to the timing of each food, early introduction of complementary foods may protect against atopic sensitization in childhood, particularly among high-risk children. Less food diversity as already at 3 months of age may increase the risk of atopic sensitization.

Early Introduction of Complementary Foods Might Prevent Allergic Disease

The timing of the introduction of complementary foods in infants is confusing for parents and clinicians alike. Older guidelines recommended avoidance

Early introduction of complementary foods: is there a link with Type 1 diabetes?

SUMMARY Early introduction of complementary foods has been demonstrated to play a role in the development of clinical and preclinical Type 1 diabetes. The evidence on the association of early introduction of cow’s milk with an increased risk of Type 1 diabetes is contradictory. Case–control studies indicate a positive association, while associations have mainly not been observed in more reliable cohort studies. Early introduction of solid foods, such as cereals and root vegetables, including potatoes, seems to be associated with an increased risk of early or advanced preclinical Type 1 diabetes.

Introduction of Complementary Foods to Infants within the First Six Months and Associated Factors in Rural Communities of JimmaArjo

Background: Although breastfeeding is one of the components of Primary Health Care in Ethiopia, a wide range of harmful infant feeding practices are documented even after the implementation of infant and young child feeding guidelines. However, no studies were documented about complementary feeding patterns and factors associated with early introduction of complementary feeding in the study area. Methods and Materials: Community based cross-sectional study was carried out in JimmaArjoWoreda from December to January 2009. Quantitative data were collected from a sample of 382 respondents supplemented by qualitative data generated using in-depth interviews of 15 key informants.Data were analyzed using SPSS version 16.0. Binary logistic regressions were used to measure the strength of association between independent and dependent variables using odds ratios and 95% of confidence intervals. Finally, multivariate logistic regression analysis was done to identify the predictors of early introduction of complementary food.Results: About 42.9% of mothers initiated complementary feeding before 6 months. The majority of mothers early initiated complementary feeding since they believed that breast milk was insufficient and influences from social beliefs. Findings from this study showed that young maternal age, child age below 1 month, child age 1-2 months, breastfeeding initiation within the first hour of child birth, having information about exclusive breastfeeding and maternal attitude about the dietary importance of breast milk for their children were negatively associated with early introduction of complementary food. However, lack of sufficient time with their children was one of predisposing factor for early introduction of the additional food before 6 months. Conclusions: Findings from this study showed that 42.9% of mothers introduced complementary food before 6 months. As this can cause malnutrition and exposure to different types of infections, the contributing factors to early introduction of complementary food should be taken into account while designing intervention strategies. In addition promotion of strong community based networks using Health Extension Workers and local community’s resource people as key actors is important to tackle this problem.

Relationship between Breastfeeding and Obesity in Childhood

A cross-sectional study was conducted to investigate the weight status and the relationship of infant-feeding variables, birthweight and birth order with BMI in a group of Iranian children. Five hundred and eleven students of both sexes at the first grade in elementary schools (aged 7 years) were recruited randomly from all 19 educational districts of Tehran. Weights and heights of children and their mothers were measured. Data on breastfeeding (BF), formula-feeding, the timing of introduction of complementary foods (CF), birthweight, and birth order were collected from the mothers. The 2007 WHO reference value was used for determining child's weight status. Regression analysis in single and a 2-level linear regression models was used for examining the independent relationships of infant-feeding variables, birthweight and birth order with childhood BMI. The prevalence of underweight and overweight in this group of children was 7.6% and 19.7%, respectively. Total time of BF and duration of exclusive BF were not associated with childhood BMI. The timing of introduction of CF was inversely related to childhood BMI after controlling for other variables (beta:-0.34; 95% CI:-0.58,-0.10). Children with an early introduction of CF had significantly higher mean BMI (p for linear trend=0.012). Birth order and birthweight were related to childhood BMI significantly. These data suggest that overweight and obesity are nutritional problems among 7 years old Teharani children. The timing of introduction of CF, birth order, and birthweight were independent predictors of childhood BMI. Neither total time of BF nor duration of exclusive breastfeeding was associated with adiposity in children.

Pregravid Body Mass Index Is Associated with Early Introduction of Complementary Foods

ObjectiveTo determine whether women who entered pregnancy overweight or obese were less likely to follow American Academy of Pediatrics guidelines for introducing complementary foods to infants after 4 months of age. In addition, we explored whether psychological factors accounted for any of the effect of pregravid body mass index on age of complementary food introduction. DesignA prospective cohort study from 2001 to 2005 that recruited pregnant women between 15 to 20 gestational weeks with follow-up through 12 months postpartum from University of North Carolina hospitals (n=550). Statistical analysisMultinomial models were used to estimate relative risk ratios. The outcome was age of complementary food introduction, categorized as younger than 4 months of age, 4 to 6 months, and 6 months or later (referent). Maternal body mass index was categorized as underweight (<18.5), normal weight (18.5 to 24.9), and overweight/obese (≥25). A series of regression analyses tested mediation by psychological factors measured during pregnancy (depressive symptoms, stress, and anxiety). ResultsMore than a third of the study population (35.7% of 550) entered pregnancy overweight/obese. The majority of participants (75.3%) introduced foods to their infants between 4 and 6 months of age. Compared with normal-weight women, those who were overweight/obese before pregnancy were more likely (relative risk ratios=2.22 [95% CI 1.23 to 4.01]) to introduce complementary foods before the infant was 4 months old, adjusting for race, education, and poverty status. Depressive symptoms, stress, and anxiety did not account for any of the effect of pregravid overweight/obesity on early food introduction. ConclusionsThe results suggest that overweight and obese women are more likely to introduce complementary foods early and that psychological factors during pregnancy do not influence this relationship. Future studies need to explore why overweight/obese women are less likely to meet the American Academy of Pediatrics recommendations for the introduction of complementary food.

Pregravid Body Mass Index Is Associated with Early Introduction of Complementary Foods

Pregravid Body Mass Index Is Associated with Early Introduction of Complementary Foods

Determinants of inappropriate timing of introducing solid, semi-solid or soft food to infants in Pakistan: secondary data analysis of Demographic and Health Survey 2006-2007.

Inappropriate timing of introducing complementary food deprives the infant of optimum nutrition, leading to undernutrition, and increased mortality and morbidity. The aim of this analysis was to identify determinants of inappropriate timing of introduction of solid, semi-solid and soft foods in Pakistan. Data on 941 infants 3.00 to 8.99 months were obtained from the Pakistan Demographic and Health Survey 2006-2007. The prevalence of introduction of foods among infants aged 3.00-5.99 months and 6.00-8.99 months was examined against a set of individual, household and community level variables using univariate analysis. Adjusted odds ratio (AOR) for early introduction in age 3.00-5.99 months and non-introduction in 6.00-8.99 months of age were calculated using backward stepwise logistic regression models. The prevalence of early introduction of complementary foods among 3.00- to 5.99-month-old and timely introduction among 6.00- to 8.99-month-old infants were 10.6% and 39.2%, respectively. Multivariate analyses revealed that mothers who had four or more antenatal clinic visits (AOR=2.68) and who lived in the provinces of Sindh (AOR=2.89) and Baluchistan (AOR=6.75) were more likely to introduce complementary foods early. Mothers from middle-level households (AOR=7.82), poorer households (AOR=4.84) and poorest households (AOR=5.72) were significantly more likely to delay introduction of complementary foods. In conclusion more than half (60.8%) of Pakistani infants do not receive complementary foods at recommended time. Public health interventions to improve the timing of introduction of complementary food are needed at national level with special focus on high risk groups.

Re: ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence? (Cattaneo et al. 2011)

Re: ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence? (Cattaneo <i>et al</i>. 2011)

Infant Feeding Practices and the Effect of Early Complementary Feeding on Child Nutritional Status in Makada, Sabon Gari Local Government Area, Kaduna State, Nigeria

Objective: The objective of this study was to determine infant feeding practices and the effect of early complementary feeding on the nutritional status of children in Makada Community, Sabon Gari Local Government Area (LGA), Kaduna State, Nigeria. Materials and Methods: A cross-sectional survey was carried out. The sample consists of 100 mothers (and their children), selected randomly from the turnout of women at the Makada Health Centre&rsquo;s Tuesday child clinic. The study instrument was a self-validated structured questionnaire that solicited information on demography, breastfeeding, types and time of complementary feeding, immunizations, age and weight of children and any special foods given to children. Data on the nutritional status of children were obtained using the weights, heights and ages of children. The association between the nutritional status of the child and the period food was introduced was evaluated using Chi- square analysis. Results: The results showed that 50% of mothers had no formal education, 33% had Islamic/primary, 10% secondary and 7% post-secondary education. On occupation, the respondents were mostly housewives (50%); 30% were food vendors, 19% were petty traders and 1% farmers. Ten percent (10%) of the respondent&rsquo;s breast fed their children with colostrums. On the question of age, time and type of food given before six months, 70% gave herbs/water, 12% gave water and pap, 5% gave infant formula/fresh cow milk, 3% gave honey/sugar, while 10% fully breastfed. Fifty-nine percent of respondents fell within the normal weight range, while the remaining 41% of 3-6 months and 7-12 months were found to be underweight. The result of the chi-square analysis revealed association between the age at which food was introduced to children and their nutritional status. Conclusion: The study concluded that early introduction of complementary foods may have negative effect on the weight of the children and is also associated with undernourishment.Key words: Feeding practices, early complementary feeding, nutritional status, child health

Impact of a strategy to prevent the introduction of non-breast milk and complementary foods during the first 6 months of life: A randomized clinical trial with adolescent mothers and grandmothers

IntroductionAlthough the disadvantages of introducing non-breast milk and the early introduction of complementary foods are known, such practices are common worldwide. ObjectiveTo evaluate the efficacy of counseling about breastfeeding and complementary feeding in preventing the introduction of non-breast milk and complementary foods in the first 6months. MethodsThis randomized clinical trial enrolled 323 adolescent mothers and their newborns and 169 maternal grandmothers; 163 mothers and 88 grandmothers received five counseling sessions on breastfeeding while in the hospital and at 7, 15, 30, and 60days, and one session on complementary feeding at 120days. Data about infant feeding were collected monthly. The impact was evaluated by comparing the Kaplan–Meier survival curves for the time of introduction of non-breast milk and complementary foods of the control and intervention groups. Median time of introduction of milk was calculated in the two groups. ResultsThe survival curves showed that the intervention postponed the introduction of non-breast milk and complementary foods. At 4months, 41% (95% CI, 32.8–49.2) of the infants in the control group received complementary foods in comparison to 22.8% (95% CI, 15.9–29.7) of the intervention group. Counseling postponed the introduction of non-breast milk, which occurred at 95days (95% CI, 8.7–111.3) in the control group and at 153days (95% CI, 114.6–191.4) in the intervention group. ConclusionsCounseling sessions on infant's first 4months were an efficacious strategy to prevent the introduction of non-breast milk and complementary foods in the 6months of life.

Reproducibility regarding the age of introduction of complementary foods to infants as self-reported by urban and rural low-income mothers in Guatemala

The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life with the introduction of adequate complementary foods thereafter. The association between the early introduction of complementary foods and negative health outcomes may be underestimated by inconsistencies in reported age-of-introduction of complementary foods. We aimed to determine the reproducibility of reported age-of-introduction of 10 selected complementary foods. Mothers of 6-12 mo old Guatemalan infants (50 rural, 64 urban) were interviewed on 3 occasions within an interval of 2-14 wks, and asked the age of their infant on introduction of 10 commonly consumed foods(Incaparina®, oatmeal, rice, fruits, vegetables, white rolls, sweet rolls, baby food in jars,potatoes and coffee). A score of 3 (full repetition), 2 (2 of 3 consistent) or 0 (3 distinct answers) was given for each food, and summed across all foods for a “maternal score”, with 30 as maximal. Baby food, sweet rolls and coffee were the most reproducibly-reported foods for both settings, whilst vegetables and fruits were the least consistently reported items. The median maternal score was 20.0 in the urban sample, and higher at 23.0 in the rural sample (p=0.020). We conclude that the moderately high degree of consistency in the responses adds confidence to the proposition that published data on age of complementary foods introduction could generally be valid. Key words: Reproducibility, complementary foods, self-reported, infant nutrition, Guatemala.

ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence?

Since 2002, the World Health Organization and many governments and professional associations have recommended exclusive breastfeeding for 6 months followed by complementary feeding (giving solid foods alongside breast milk) as optimal infant feeding practice. Several articles have been published challenging this recommendation. Arguably, the most influential has been the 2008 commentary of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, which recommended that complementary foods should be introduced to all infants between 17 and 26 weeks. We challenge the validity of ESPGHAN's position, questioning the adequacy of the literature search, the interpretation and evidence used to reach their conclusions and the balance of an approach that focuses on disease prevention, with scant consideration of growth and neuromotor development. We contend that ESPGHAN's position should be understood as an expert opinion that may be influenced by conflicts of interest. In our view, the ESPGHAN position paper is not evidence based and does not justify a change of the current public health recommendation for 6 months of exclusive breastfeeding. At an individual level, health professionals should understand that developmental readiness for starting solid foods has an age range like other developmental milestones; that fewer infants will probably be ready to start complementary feeding before, rather than after, 6 months; and that their role is to equip parents with the confidence and skills to recognise the signs of developmental readiness. This empowerment process for infants and parents should be preferred over the prescriptive ESPGHAN approach.

Feeding practices among children attending child welfare clinics in Ragama MOH area: a descriptive cross-sectional study

BackgroundFeeding during early childhood is important for normal physical and mental growth as well as for health in later life. Currently, Sri Lanka has adopted the WHO recommendation of exclusive breastfeeding for six months, followed by addition of complementary feeds thereafter, with continuation of breastfeeding up to or beyond two years. This study was conducted to evaluate the current feeding practices among Sri Lankan children during early childhood.MethodsThis study was a descriptive cross-sectional study conducted in the Ragama Medical Officer of Health (MOH) area. It was conducted between 10 August 2010 and 30 October 2010. Children between the ages of 24 and 60 months, attending child welfare clinics, were included in the study on consecutive basis. An interviewer-administered questionnaire was used to collect data regarding sociodemographic characteristics and feeding practices.ResultsThere were 208 boys and 202 girls in the study population. Of them, 255 (62.2%) were exclusively breastfed up to 6 months. Younger children had a statistically significant, higher rate of exclusive breastfeeding compared to older children. Three hundred and fifty one (85.6%) children had received infant formula, and it was started before the age of 6 months in 61 children, and in 212 before one year. Sugar was added to infant formula in 330 (80.4%) children, and out of them 144 had sugar added within first year of life. Complementary foods were started before 4 months in 29 (7%) children. Of the 410 children, 294 (71.7%) were breastfed beyond 2 years and 41.6% of them were breastfed at regular intervals throughout the day. Three hundred and thirty eight (82.6%) children were receiving overnight feeding of either breast milk or infant formula even after 2 years.ConclusionsThough a high rate of exclusive breastfeeding was observed in this study population, there are many other issues related to feeding during the early years of life that need immediate intervention. Too early introduction of complementary food, using infant formula without an indication, adding sugar to infant formula, too frequent breastfeeding and overnight feeding of older children are among them.

WHO framework case study: Carbamates

This study examined non-maternal involvement in feeding during the first 2 years of life and its association with breastfeeding duration, early introduction of complementary foods, and dietary intakes of selected foods and beverages. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 low-income, African–American mother–infant dyads, followed from 3 to 18 months postpartum. Non-maternal caregivers (NMCs) were defined as persons involved in feeding an infant/toddler 50% or more of the total daily feedings. Use of any NMC and the type of NMC was tabulated for each study visit (3, 6, 9, 12, and 18 months). At each time point, more than half of all households reported a NMC. Fathers, grandmothers, and licensed childcare providers were the most common types of NMCs. In longitudinal models adjusted for confounding variables, NMC use was associated with a decreased likelihood of continued breastfeeding, and an increased likelihood of infants and toddlers consuming juice or whole fruit. Given the high prevalence of non-maternal involvement in feeding, interventions targeting multiple family members are warranted as they are likely to be more effective than those targeting the mother alone.

Complementary feeding practices and dietary intake among children 12-23 months in Mwingi district, Kenya

A cross-sectional study was carried out among 280 children (12-23 months), Mwingi district, Kenya. Complementary foods were introduced at age 2.5 ± 1.7 months and the mean duration of breastfeeding was 10.5 ± 4.1 months. An unfortified maize porridge was the main complementary food. At least 60% of the children in all the dietary diversity terciles consumed starchy staples and oils in the preceding 24 hr. The mean dietary diversity score was 4.9 ± 1.3 and 4.3 ± 1.0 out of a possible score of 14 and 8 as suggested by FAO, respectively. Dietary diversity was limited in animal products. Deficits in dietary energy, iron and zinc were found due to early introduction of complementary foods and low consumption of food rich in iron. Establishing local solutions to increase dietary diversity and promote use of foods rich in iron and proteins to improve available complementary diets are needed.

Complementary Food Consumption of Canadian Infants

In July, 2003, a cross-sectional survey was conducted by Heinz Canada, on a nationally representative sample of mothers with infants aged three to 12 months. The surveys mailed to new mothers consisted of 1) a questionnaire to as- sess demographic information and 2) a four day food diary, providing dietary data for nearly 2,951 infants. The initiation rate of breastfeeding was 73% for study infants. At three months, 81% of the infants received complementary foods (mostly cereal, fruits, and vegetables, but some had also been introduced to meats, dairy products, and mixed dishes). These data suggest a current pattern for the early introduction of complementary foods, some by three months and the ma- jority by six months of age. The World Health Organization (WHO) and Health Canada now recommend exclusive breastfeeding until six months of age. The impact this recommendation may have on the feeding pattern of Canadian in- fants remains to be seen.

Infant Feeding and Feeding Transitions During the First Year of Life

Infancy is a time of rapid transition from a diet of virtually nothing but milk (either breast milk or infant formula) to a varied diet from nearly all food groups being consumed on a daily basis by most infants. Despite various recommendations about infant feeding, little is known about actual patterns of feeding among US infants. This article documents transitions in infant feeding patterns across the first year of life and determinants of key aspects of infant feeding. Using data from the Infant Feeding Practices Study II, we analyzed responses to a 7-day food-recall chart that was administered every month. The sample size declined from 2907 at birth to 1782 at 12 months of age. Although 83% of survey respondents initiated breastfeeding, the percentage who breastfed declined rapidly to 50% at 6 months and to 24% at 12 months. Many of the women who breastfed also fed their infants formula; 52% reported that their infants received formula while in the hospital. At 4 months, 40% of the infants had consumed infant cereal, 17% had consumed fruit or vegetable products, and <1% had consumed meat. Compared with infants who were not fed solid foods at 4 months, those who were fed solid foods were more likely to have discontinued breastfeeding at 6 months (70% vs 34%) and to have been fed fatty or sugary foods at 12 months (75% vs 62%). Supplementing breast milk with infant formula while infants were still in the hospital was very common. Despite recommendations that complementary foods not be introduced to infants aged 4 months or younger, almost half of the infants in this study had consumed solid foods by the age of 4 months. This early introduction of complementary foods was associated with unhealthful subsequent feeding behaviors.

Psychosocial Determinants of the Early Introduction of Complementary Foods

Infant feeding guidelines recommend exclusive breast-feeding to the age of 6 months; complementary foods should not be introduced before this age. This study examined parent and infant psychosocial determinants of the early introduction of complementary foods. Analyses were conducted on a representative sample of children born in Québec (Canada) in 1998 (n = 2,223), surveyed through the Québec Longitudinal Study of Child Development. Of the children, 61% received complementary foods prior to the age of 4 months. A multiple logistic regression analysis revealed the early introduction of complementary foods was more likely when mothers were younger, less educated, of lower socioeconomic class, and when they felt they had little influence on their child's development. Higher parental confidence in caring for the infant was also associated with the early introduction of complementary foods (p < or = .05). Future research must carefully consider the psychosocial aspects involved in adhering to infant feeding guidelines.