Micronutrient deficiencies and imbalanced dietary intake tend to occur during the reproductive period among women in China. In accordance with traditional Chinese culture, pregnant women are commonly advised to follow a specific set of dietary precautions. The purpose of this study was to assess dietary intake data and identify risk factors for nutritional inadequacy in pregnant women from urban and rural areas of Deyang region, Sichuan province of China. Cross-sectional sampling was applied in two urban hospitals and five rural clinics (randomly selected) in Deyang region. Between July and October 2010, a total of 203 pregnant women in the third trimester, aged 19–42 years, were recruited on the basis of informed consent during antenatal clinic sessions. Semi-structured interviews on background information and 24-h dietary recalls were conducted. On the basis of self-reported height and pre-pregnancy weight, 68.7% of the women had a pre-pregnancy body mass index (BMI) within the normal range (18.5 ≤ BMI < 25), 26.3% were found to be underweight with a BMI <18.5 (20.8% in urban vs. 35.6% in rural areas), while only 5.1% were overweight with a BMI ≥30. In view of acceptable macronutrient distribution ranges (AMDRs) the women’s overall dietary energy originated excessively from fat (39%), was low in carbohydrates (49.6%), and reached the lower limits for protein (12.1%). Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake (RNI) fulfillment levels for energy (106.1% vs. 93.4%), fat (146.6% vs. 119.7%), protein (86.9% vs. 71.6%), vitamin A (94.3% vs. 65.2%), Zn (70.9% vs. 61.8%), Fe (56.3% vs. 48%), Ca (55.1% vs. 41%) and riboflavin (74.7% vs. 60%). The likelihood of pregnant women following traditional food recommendations, such as avoiding rabbit meat, beef and lamb, was higher in rural (80%) than in urban (65.1%) areas. In conclusion, culturally sensitive nutrition education sessions are necessary for both urban and rural women. The prevalence of underweight before conception and an insufficient supply of important micronutrients were more pronounced in rural areas. Therefore, attention must be given to the nutritional status, especially of rural women before, or at the latest, during pregnancy. Full article

The aims of this study were to: (1) determine whether replacement of cow’s milk protein with soy resolves Chronic Functional Constipation (CFC); and (2) investigate the effects of cow’s milk β casein A1 and cow’s milk β casein A2 on CFC. Children diagnosed with CFC were recruited to one of two crossover trials: Trial 1 compared the effects of cow’s milk and soy milk; Trial 2 compared the effects of cow’s milk β casein A1 and cow’s milk β casein A2. Resolution of constipation was defined as greater than eight bowel motions during a two week intervention. Thirteen children (18 to 144 months) participated in Trial 1 (6 boys, 7 girls). Nine participants who completed the soy epoch all experienced resolution (p < 0.05). Thirty-nine children (21 to 144 months) participated in Trial 2 (25 boys, 14 girls). Resolution of constipation was highest during the washout epoch, 81%; followed by cow’s milk β casein A2, 79%; and cow’s milk β casein A1, 57%; however, the proportions did not differ statistically. The results of Trial 1 demonstrate an association between CFC and cow’s milk consumption but Trial 2 failed to show an effect from type of casein. Some other component in cow’s milk common to both A1 and A2 milk may be causing a problem in these susceptible children. Full article

Objectives: To examine factors that impact on breastfeeding duration among Western Australian Aboriginal children. We hypothesised that Aboriginal children living in remote locations in Western Australia were breastfed for longer than those living in metropolitan locations. Methods: A population-based cross-sectional survey was conducted from 2000 to 2002 in urban, rural and remote settings across Western Australia. Cross-tabulations and multivariate logistic regression analyses were performed, using survey weights to produce unbiased estimates for the population of Aboriginal children. Data on demographic, maternal and infant characteristics were collected from 3932 Aboriginal birth mothers about their children aged 0–17 years (representing 22,100 Aboriginal children in Western Australia). Results: 71% of Aboriginal children were breastfed for three months or more. Accounting for other factors, there was a strong gradient for breastfeeding duration by remoteness, with Aboriginal children living in areas of moderate isolation being 3.2 times more likely to be breastfed for three months or more (p < 0.001) compared to children in metropolitan Perth. Those in areas of extreme isolation were 8.6 times more likely to be breastfed for three months or longer (p < 0.001). Conclusions: Greater residential isolation a protective factor linked to longer breastfeeding duration for Aboriginal children in our West Australian cohort. Full article

Nutrition during pregnancy can induce alterations in offspring phenotype. Maternal ratio of protein to non-protein (P:NP) energy has been linked to variations in offspring body composition and adult risk of metabolic disease. This study describes the dietary patterns of pregnant women by tertiles of the P:NP ratio and compares diet to Australian recommendations. Data are from 179 Australian women enrolled in the Women and Their Children’s Health Study. Diet was assessed using a validated 74-item food frequency questionnaire. Food group servings and nutrient intakes were compared to the Australian Guide to Healthy Eating and Australian Nutrient Reference Values. Higher maternal P:NP tertile was positively associated with calcium (P = 0.003), zinc (P = 0.001) and servings of dairy (P = 0.001) and meat (P = 0.001) food groups, and inversely associated with the energy dense, nutrient poor non-core (P = 0.003) food group. Micronutrient intakes were optimized with intermediate protein (18%E–20%E), intermediate fat (28%E–30%E) and intermediate carbohydrate (50%E–54%E) intakes, as indicated in tertile two. Results suggest a moderate protein intake may support pregnant women to consume the largest variety of nutrients across all food groups. Full article

Antioxidant intakes in pregnancy may influence fetal immune programming and the risk of allergic disease. We investigated associations between maternal intakes of β-carotene, vitamin C, vitamin E, copper and zinc, and infant allergic outcomes. Antioxidant intakes of pregnant women (n = 420) assessed prospectively by a food frequency questionnaire, were examined in relation to allergic outcomes at 1 year of age (n = 300). The main relationships with allergic outcomes were seen with dietary vitamin C and copper. Specifically, higher maternal dietary vitamin C intake was associated with a reduced risk of any diagnosed infant allergic disease and wheeze. After adjustment for potential confounders the relationship with wheeze remained statistically significant. There was also an inverse linear relationship between vitamin C and food allergy. Higher dietary copper intake was associated with reduced risk of eczema, wheeze and any allergic disease. The relationship with wheeze and any allergic disease remained statistically significant in multivariate analysis, and there was also an inverse linear relationship between copper and food allergy. However, these relationships were only seen for nutrients present in food. There were no relationships between β-carotene, vitamin E or zinc and any allergic outcomes. In summary, this study suggests that maternal diet of fresh foods rich in vitamin C is associated with reduced risk of infant wheeze, and that copper intake is associated with reduced risk of several allergic outcomes. Full article

The aim of this study was to investigate the association of breastfeeding duration and food variety at 2 years of age. A secondary data analysis was undertaken of the Western Australian Pregnancy Cohort (Raine) Study, an ongoing longitudinal study. Data collected from a single 24 h dietary recall of 1905, 2 year-old children were used to calculate two food variety scores; a core food variety score (CFVS) and a fruit and vegetable variety score (FVVS). Multivariate linear regression analysis was used to identify those factors independently associated with the CFVS and FVVS. The mean CFVS was 7.52 (range 1–18) of a possible 34 food items or groups and the mean FVVS was 2.84 (range 0–10) of a possible 16 food items or groups. Breastfeeding duration was independently directly associated with the CFVS (p < 0.001) and FVVS (p < 0.001). In addition, maternal age was independently directly associated with the CFVS (p < 0.001) and FVVS (p = 0.001) as was maternal education (CFVS p < 0.001 and FVVS p = 0.043). The presence of older siblings was independently inversely associated with the CFVS (p = 0.003) and FVVS (p = 0.001). This study demonstrated a direct modest association between breastfeeding duration and food variety in 2 year-old children, independent of maternal demographic characteristics known to predict food variety in children. This finding supports the hypothesis that flavours transferred in breast milk provide repeated early exposure to different tastes and positively shape children’s food preferences and food variety. Full article

Only 50% of Dutch children aged 0–4 years receive sufficient daily vitamin D supplementation. This study aims to investigate the effectiveness of implementation intentions in promoting vitamin D supplementation among young children. An electronic survey was conducted among parents of children aged 0–4 (n = 171). These parents were randomly assigned to two groups: one that received implementation intention instructions and one that did not. At follow-up, there were no significant between group differences in any outcome measures. These results suggest that merely asking parents to formulate an implementation intention with respect to giving their child daily vitamin D supplementation is insufficient to improve vitamin D intake among young children. However, testing the intervention via the Internet may not have allowed us to exploit the full potential of the strategy. Investigation of the use of implementation intentions in the setting of toddler consultation clinics is therefore recommended. Full article

Recent research has shown that the pattern of change over time, or trajectory, of body mass index (BMI) varies among children. However, the factors that underlie the heterogeneity in these trajectories remain largely unexplored. Our aim was to use a growth mixture model to empirically identify classes of BMI trajectories (from birth to 11.5 years) and examine the effects of breastfeeding, introduction of solids, as well as food and nutrient intake at 18 months on these BMI trajectories. We identified three BMI growth trajectories between birth and age 11.5 years, separately in boys and girls. Breastfeeding duration less than six months and the early introduction of solids did not adversely influence BMI trajectories in our sample but high intakes of meat, particularly high fat varieties, and high intakes of carbohydrate at age around 18 months were associated with a high BMI trajectory in boys. It is not clear whether these dietary factors confer a direct risk of higher BMI in childhood or are markers for other dietary patterns that are present early and/or develop through childhood and contribute to higher BMI. Full article

Dietary patterns are a useful summary measure of diet. Few studies have examined the nutrient profiles underpinning the dietary patterns of young children. The study aim is to determine whether dietary patterns at 6 and 15 months of age are associated with nutrient intakes at 8 and 18 months, respectively. Participants were children from the Avon Longitudinal Study of Parents and Children who had complete dietary pattern and nutrient intake data (n = 725 at 6–8 months, n = 535 at 15–18 months). The association between tertiles of dietary pattern scores and nutrient intake was examined using a non-parametric test for trend. Scores on the home-made traditional pattern (6–8 months) were positively associated with median energy intake. Each dietary pattern had different associations with energy-adjusted intakes of macro- and micro-nutrients. At both times, the discretionary pattern was positively and the ready-prepared baby foods pattern was negatively associated with sodium intake. At 6–8 months, calcium and iron intakes decreased across scores on the home-made traditional and breastfeeding patterns, but increased across the ready-prepared baby food patterns. These findings highlight that dietary patterns in infants and toddlers vary in their underlying energy and nutrient composition. Full article

When a mother’s milk is unavailable, the best alternative is donor milk (DM). Milk delivered to Human Milk Banks should be pasteurized in order to inactivate the microbial agents that may be present. Currently, pasteurization, performed at 62.5 °C for 30 min (Holder Pasteurization, HoP), is recommended for this purpose in international guidelines. Several studies have been performed to investigate the effects of HoP on the properties of DM. The present paper has the aim of reviewing the published papers on this topic, and to provide a comparison of the reported variations of biologically-active DM components before and after HoP. This review was performed by searching the MEDLINE, EMBASE, CINHAL and Cochrane Library databases. Studies that clearly identified the HoP parameters and compared the same DM samples, before and after pasteurization, were focused on. A total of 44 articles satisfied the above criteria, and were therefore selected. The findings from the literature report variable results. A possible explanation for this may be the heterogeneity of the test protocols that were applied. Moreover, the present review spans more than five decades, and modern pasteurizers may be able to modify the degradation kinetics for heat-sensitive substances, compared to older ones. Overall, the data indicate that HoP affects several milk components, although it is difficult to quantify the degradation degree. However, clinical practices demonstrate that many beneficial properties of DM still persist after HoP. Full article

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed. Full article

Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a “health equalizer” and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers’ training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages. Full article

There is a growing recognition of the need for a lifecourse approach to understanding the aetiology of adult disease, and there is now significant evidence that links patterns of infant feeding to differences in health outcomes, both in the short and longer term. Breastfeeding is associated with lower rates of infection in infancy; in high-income populations, it is associated with reductions in blood pressure and total blood cholesterol, and lower risks of obesity and diabetes in adult life. Breastfeeding rates are suboptimal in many countries, and strategies to promote breastfeeding could therefore confer important benefits for health at a population level. However, there are particular challenges in defining nutritional exposures in infancy, including marked social gradients in initiation and duration of breastfeeding. In recent studies of low and middle-income populations of children and young adults, where the influences on infant feeding practice differ, beneficial effects of breastfeeding on blood pressure, BMI and risk of diabetes have not been confirmed, and further information is needed. Little is currently known about the long-term consequences of differences in the timing and nature of the weaning diet. Future progress will depend on new studies that provide detailed prospective data on duration and exclusivity of breastfeeding together with appropriate characterisation of the weaning diet. Full article