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1.
Complementary Feeding, Infant Growth, and Obesity Risk: Timing, Composition, and Mode of Feeding.
Grote, V, Theurich, M, Luque, V, Gruszfeld, D, Verduci, E, Xhonneux, A, Koletzko, B
Nestle Nutrition Institute workshop series. 2018;:93-103
Abstract
The complementary feeding period is a short transitional period from breastfeeding and formula feeding to family foods. Timing, quantity, and quality are implied to impact growth and obesity risk. We summarized the literature and analyzed data of monthly 3-day food diaries of >1,000 children from 5 European countries in the first 2 years of life, which were collected as part of the prospective European Childhood Obesity Project (CHOP Study). Formula-fed children started complementary food approximately 2 weeks earlier than breastfed children, and almost 40% of them at or before 4 months of age. While introduction of solids between 4 and 6 months or after 6 months does not seem to impact growth and later obesity risk, solids before 4 months of age increased the risk. There are indications that this is especially problematic for formula-fed children. During the complementary feeding period, fat intake decreases, and protein and carbohydrate intakes increase. Protein intake often exceeds European recommendations from 9 months onwards. However, the role of macronutrients during complementary feeding in growth and metabolism needs further clarification. Findings on the role of responsive feeding or baby-led feeding during complementary feeding in growth are not conclusive. In summary, while introduction of complementary foods before 4 months of age should be avoided, the impact of the quality of complementary food on short-term growth and later obesity risk has to be elucidated further.
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2.
Postdischarge Feeding of Very-low-birth-weight Infants: Adherence to Nutrition Guidelines.
Francis, J, Unger, S, Bando, N, Vance, A, Gibbins, S, Kiss, A, Church, P, Sellen, D, O'Connor, DL, ,
Journal of pediatric gastroenterology and nutrition. 2018;(3):401-408
Abstract
OBJECTIVES Infant feeding guidelines are important public health strategies to promote optimal growth, development, and chronic disease prevention, but their effectiveness is contingent upon families' ability to adhere to them. Little is known of adherence to guidelines among nutritionally vulnerable infants, specifically those born very-low-birth-weight (VLBW) (<1500 g). This study investigated whether postdischarge feeding practices for VLBW infants align with current recommendations and explored parental and infant baseline sociodemographics related to these practices. METHODS Prospectively collected data from families of 300 VLBW infants participating in a randomized clinical trial (ISRCTN35317141) were used. Baseline demographics were obtained at enrollment and postdischarge feeding practices via monthly telephone questionnaires to 6 months corrected age (CA). RESULTS At discharge, 4 and 6 months CA, 72%, 39%, and 29% of infants received any amount of mother's milk, respectively; exclusive breast-feeding rates were 49%, 20%, and 6%, respectively. Among infants receiving mother's milk, rates of vitamin D supplementation were ≥83%. Recommendations for introducing solids between 4 and 6 months CA were followed by 71% of the cohort and for iron supplementation by 58%. Overall, 12% of infants adhered to all aforementioned recommendations. Mothers with university degrees were more likely to provide mother's milk, whereas mothers of Middle Eastern/South Asian ethnicity were less likely to provide mother's milk. CONCLUSIONS Low rates of partial and exclusive breast-feeding of VLBW infants to 6 months CA were reported. Overall adherence to iron supplementation was low. Strategies to provide increased support for mothers identified as at-risk should be developed.
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3.
Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review.
Manikam, L, Lingam, R, Lever, I, Alexander, EC, Amadi, C, Milner, Y, Shafi, T, Stephenson, L, Ahmed, S, Lakhanpaul, M
Nutrients. 2018;(11)
Abstract
Sub-optimal nutrition among South Asian (SA) children living in high-income countries is a significant problem. High rates of obesity have been observed in this population, and differential complementary feeding practices (CFP) have been highlighted as a key influence. Our aim was to undertake a systematic review of studies assessing CFP in children under two years of age from SA communities living in high-income countries, including dietary diversity, timing, frequency and promotors/barriers. Searches covered January 1990⁻July 2018 using MEDLINE, EMBASE, Global Health, Web of Science, BanglaJOL, OVID Maternity and Infant Care, CINAHL, Cochrane Library, POPLINE and World Health Organisation (WHO) Global Health Library. Eligible studies were primary research on CFP in SA children aged 0⁻2 years. Search terms were "children", "feeding" and "South Asian", and derivatives. Quality appraisal used the Evidence for Policy and Practice Information (EPPI) Weight of Evidence scoring. From 50,713 studies, 13 were extracted with ten from the UK, and one each from the USA, Canada and Singapore. Sub-optimal CFP were found in all studies. All ten studies investigating timing reported complementary feeding (CF) being commenced before six months. Promoters/barriers influencing CFP included income, lack of knowledge, and incorrect advice. This is the first systematic review to evaluate CFP in SA children living in high-income countries and these findings should inform the development of effective interventions for SA infants in these settings.
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4.
Effects and Tolerance of Protein and Energy-Enriched Formula in Infants Following Congenital Heart Surgery: A Randomized Controlled Trial.
Cui, Y, Li, L, Hu, C, Shi, H, Li, J, Gupta, RK, Liang, H, Chen, X, Gong, S
JPEN. Journal of parenteral and enteral nutrition. 2018;(1):196-204
Abstract
BACKGROUND Nutrition support is important for clinical management to improve outcomes of infants following congenital heart surgery. Protein-enriched and energy-enriched formula (PE-formula) may help provide adequate nutrition and promote wound healing. However, the effects and tolerance of increased protein and energy intakes of these infants have not been well defined. OBJECTIVE To evaluate nutrition effects and tolerance of a PE-formula compared with the standard formula (S-formula) in infants in the first 5 days after congenital heart surgery. METHODS Fifty infants were randomly assigned to S-formula (S-group, n = 24) or PE-formula (PE-group, n = 26). Daily nutrient intakes and tolerance were recorded. Plasma amino acid concentrations were measured. Cumulative energy balance and nitrogen balance were calculated. RESULTS Nutrient intakes were significantly higher in the PE-group after day 1, and all met the adequate intakes as early as day 2. Nitrogen balance in the PE-group met positive balance from day 2, whereas in the S-group, this was not until day 5. The PE-group also had a significantly higher increase in many essential amino acids. With the exception of tolerable diarrhea (multivariate adjusted hazard ratio, 3.16; 95% confidence interval, 1.24-8.01), the PE-group did not have a significantly higher incidence of intolerable events. CONCLUSIONS In infants during the early postoperative period after congenital heart surgery, early administration of PE-formula was as well tolerated as S-formula and effective in achieving higher nutrition intakes and earlier nitrogen balance. Further research is warranted to support the use of PE-formula in this special group of infants.
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5.
Solid Food Introduction and the Development of Food Allergies.
Caffarelli, C, Di Mauro, D, Mastrorilli, C, Bottau, P, Cipriani, F, Ricci, G
Nutrients. 2018;(11)
Abstract
The rise of food allergy in childhood, particularly among developed countries, has a significant weight on public health and involves serious implications for patients' quality of life. Even if the mechanisms of food tolerance and the complex interactions between the immune system and environmental factors are still mainly unknown, pediatricians have worldwide implemented preventive measures against allergic diseases. In the last few decades, the prevention of food allergy has tracked various strategies of complementary feeding with a modification of international guidelines from delayed introduction to early weaning. Current evidence shows that complementary foods, including allergenic ones, should be introduced into diet after four months, or even better, following World Health Organization advice, around six months irrespective of risk for allergy of the individual. The introduction of peanut is recommended before 12 months of age among infants affected by severe eczema and/or egg allergy to diminish the occurrence of peanut allergy in countries with high peanut consumption. The introduction of heated egg at 6⁻8 months of age may reduce egg allergy. Infants at high risk of allergy similarly to healthy children should introduce complementary foods taking into account family and cultural preferences.
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6.
Strategies for improving early nutritional outcomes in children with oesophageal atresia and congenital diaphragmatic hernia.
Fitzgerald, DA, Kench, A, Hatton, L, Karpelowsky, J
Paediatric respiratory reviews. 2018;:25-29
Abstract
Post-natal growth in surgical lung conditions, such as congenital diaphragmatic hernia and oesophageal atresia with tracheo-oesophageal fistula, is often sub-optimal in the early years of life when lung growth is occurring. Whilst constitutional, behavioural and mechanical factors may contribute to poor feeding and weight gain, there is a common path of management with greater caloric supplementation that may change growth trajectories and potentially lead to better respiratory, anthropometric and cognitive outcomes. We provide simple, single page, feeding supplementation sheets in three age groups: 0-6months, 6-12months and 12-24months that have proven useful for enhancing weight gain in our patients.
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7.
Structure and Digestion of Common Complementary Food Starches.
Lin, AH
Journal of pediatric gastroenterology and nutrition. 2018;:S35-S38
Abstract
Starch is the major source of dietary glucose for rapid development of children. Starches from various crops naturally differ in molecular structures and properties. Cooking, processing, and storage may change their molecular properties and affect their digestibility and functionality. Starch digestion is affected by its susceptibility to α-amylase and α-glucosidase (maltase), and the susceptibility is determined by starch granule architecture and glucan structures, as well as the interaction between starch and other food components. Starch is given as a complementary feeding to young children in many cultures, and starch or modified starch, is used in special formulae of infant foods or supplements. Although indigestible starch does not provide much energy, it can benefit colonic health.
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8.
Baby-led complementary feeding: Randomized controlled study.
Dogan, E, Yilmaz, G, Caylan, N, Turgut, M, Gokcay, G, Oguz, MM
Pediatrics international : official journal of the Japan Pediatric Society. 2018;(12):1073-1080
Abstract
BACKGROUND Baby-led weaning (BLW) is an approach to introducing solid foods to infants that gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intake in 6-12-month-old infants fed by traditional or baby-led complementary feeding. METHODS We recruited 280 healthy 5-6-month-old infants allocated to a control (traditional spoon feeding; TSF) group or an intervention (BLW) group in a randomized controlled trial. Infant growth, hematologic parameters and iron intake were evaluated at age 12 months. RESULTS Infants in the TSF were significantly heavier than those in the BLW group. Mean weight in the BLW group was 10.4 ± 0.9 kg compared with 11.1 ± 0.5 kg in the TSF group. There was no statistically significant difference in the iron intake from complementary foods between the BLW (7.97 ± 1.37 mg/day) and TSF (7.90 ± 1.68 mg/day) participants who completed the diet records. Hematologic parameters were similar at 12 months. The incidence of choking reported in the weekly interviews was not different between the groups. CONCLUSIONS To the best of our knowledge, this is the first randomized -controlled study to have examined the impact of weaning method on iron intake, hematological parameters and growth in breast-fed infants. BLW can be an alternative complementary feeding type without increasing the risk of iron deficiency, choking or growth impairment.
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9.
Anthropometry and Body Composition of Preterm Neonates in the Light of Metabolic Programming.
Parlapani, E, Agakidis, C, Karagiozoglou-Lampoudi, T
Journal of the American College of Nutrition. 2018;(4):350-359
Abstract
The improved survival of preterm infants has led to increased interest regarding their health as adults. In the context of metabolic programming, the connection between perinatal and early postnatal nutrition and growth with health in later life has brought to the fore the role of catch-up growth during the first months of preterm infants' lives and its association with body fat and obesity in childhood or puberty. A state-of-the art review was conducted in order to assess the way catch-up is evaluated, in terms of timing and rate. Adequate growth is of major importance for neurodevelopment; however, it may compete with adiposity or metabolic health. Studies based on body composition assessment have given conflicting results as regards the effect of early versus late and rapid versus slow catch-up growth on later health, mainly attributed to the lack of established criteria and definitions. Given that adequate early nutrition is crucial for the neurodevelopment of preterm infants, further studies are needed on the role of catch-up growth in long-term outcome, using generally accepted qualitative and quantitative criteria.
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10.
Reduction of Arachidonate Is Associated With Increase in B-Cell Activation Marker in Infants: A Randomized Trial.
Miklavcic, JJ, Larsen, BM, Mazurak, VC, Scalabrin, DM, MacDonald, IM, Shoemaker, GK, Casey, L, Van Aerde, JE, Clandinin, MT
Journal of pediatric gastroenterology and nutrition. 2017;(3):446-453
Abstract
BACKGROUND Infants who are not breast-fed benefit from formula with both docosahexaenoic acid (C22:6n3) and arachidonic acid (ARA; C20:4n6). The amount of ARA needed to support immune function is unknown. Infants who carry specific fatty acid desaturase (FADS) polymorphisms may require more dietary ARA to maintain adequate ARA status. OBJECTIVE The aim of the study was to determine whether ARA intake or FADS polymorphisms alter ARA levels of lymphocytes, plasma, and red blood cells in term infants fed infant formula. METHODS Infants (N = 89) were enrolled in this prospective, double-blind controlled study. Infants were randomized to consume formula containing 17 mg docosahexaenoic acid and 0, 25, or 34 mg ARA/100 kcal for 10 weeks. Fatty acid composition of plasma phosphatidylcholine and phosphatidylethanolamine, total fatty acids of lymphocytes and red blood cells, activation markers of lymphocytes, and polymorphisms in FADS1 and FADS2 were determined. RESULTS Lymphocyte ARA was higher in the 25-ARA formula group than in the 0- or 34-ARA groups. In plasma, 16:0/20:4 and 18:0/20:4 species of phosphatidylcholine and phosphatidylethanolamine were highest and 16:0/18:2 and 18:0/18:2 were lowest in the 34-ARA formula group. In minor allele carriers of FADS1 and FADS2, plasma ARA content was elevated only at the highest level of ARA consumed. B-cell activation marker CD54 was elevated in infants who consumed formula containing no ARA. CONCLUSIONS ARA level in plasma is reduced by low ARA consumption and by minor alleles in FADS. Dietary ARA may exert an immunoregulatory role on B-cell activation by decreasing 16:0/18:2 and 18:0/18:2 species of phospholipids. ARA intake from 25 to 34 mg/100 kcal is sufficient to maintain cell ARA level in infants across genotypes.