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PubMed2004

Macronutrient and selected vitamin intakes from complementary foods of infants and toddlers from Cebu, Philippines.

Intakes of macronutrients (energy, protein, fat, and carbohydrate) and vitamins (vitamin A, thiamin, riboflavin, niacin, and vitamin C) (per day and per 100 kcal) from complementary foods by a cohort of Filipino breast-fed infants and toddlers (n=1794) were studied at 10, 16, and 22 months of age using a single 24-h recall. With the exception of protein, intakes of energy and vitamins for all age groups were below the World Health Organization estimated needs and desired nutrient densities from complementary foods regardless of breast-feeding frequency. Nutrient deficits were greater for rural children compared with urban children, and were attributed to low intakes of energy, as well as cellular animal protein, fruits and vegetables.

Breast Feeding↗

PubMed2003

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants.

The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status, linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape, South Africa. The study was designed as an intervention study. In both the experimental and control groups, serum retinol concentration showed a decline over the intervention period of 6 months. The decline was less pronounced in the experimental group. This resulted in a significantly (P<005) higher serum retinol concentration at 12 months in the experimental group (26.8+/-5.8 microg/dl) compared with the control group (21.4+/-5 microg/dl). Serum iron concentration also declined over the intervention period. The decline was less pronounced in the experimental group. No difference was observed in haemoglobin levels between the groups at 12 months. Serum zinc concentration did not differ significantly between the two groups at follow up. Weight gain over the 6 months period did not differ significantly between the experimental (2.1+/-0.9 kg) and control groups (2.1+/-1.2 kg). There was no difference in linear growth between the experimental (10.0+/-1.5 cm) and control group (10.1+/-2.1 cm) at the end of the follow-up period. Weight and length at 6 months significantly predicted weight and length at 12 months. No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention. Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group. No benefit was observed in serum zinc concentration, linear growth and psychomotor development.

Child Development↗

PubMed2003

Approaches to improve iron bioavailability from complementary foods.

The importance of trace element bioavailability in the etiology of nutritional deficiencies, for example in the etiology of iron deficiency and iron deficiency anemia, can be expected to be most pronounced in individuals with high requirements. Of special concern is the situation in poor communities where infants and young children are consuming monotonous, cereal-based diets. Traditionally, cereal-based gruels are often one of the first semisolid foods to be introduced into the infant's diet. These foods can be expected to have low energy and nutrient density as well as low bioavailability of iron due to the presence of phytic acid. Ascorbic acid is a potent enhancer of non-heme iron absorption that can overcome the inhibiting effect of phytic acid when present in high enough quantities. However, home prepared complementary foods based on cereals and legumes contain negligible amounts of ascorbic acid unless ascorbic acid-rich foods are mixed with the cereal or consumed at the same time. Different approaches to improve iron bioavailability from plant-based complementary foods, e.g., by enzymatic degradation of phytic acid and/or by increased consumption of ascorbic acid-rich foods, should be explored and adapted to local conditions. In addition, there is a need to evaluate efficacy and effectiveness of strategies to increase the dietary intake of bioavailable iron by dietary diversification and food fortification under realistic conditions.

Ascorbic Acid↗

PubMed2005

Short-term effect of oil supplementation of complementary food on total ad libitum consumption in 6- to 10-month-old breastfed Indian infants.

OBJECTIVES: To evaluate the short term effect of oil supplementation of complementary food on total ad libitum consumption in breastfed infants. METHODS: Twenty infants between 6 to 10 months of age were studied in a tertiary hospital in New Delhi for 48 hours. They were given three semi-solid complementary feeds per day and ad libitum breastfeeding. No other food or fluid was allowed during the study period. A traditional gruel made of rice and pulses with high energy density (oil added; caloric density = 35 kcal/100 g) or low energy density (without oil; caloric density = 20 kcal/100 g) was offered in a randomized manner on consecutive days to all infants. Total caloric intake from breast milk and semi-solids was computed for each day. RESULTS: Infants consumed an equivalent amount of semi-solid (mean difference, 10.75 g/day; 95% confidence interval, 10.56 to 32.06; P = 0.304) and a lower amount of breast milk (mean difference, 121.1 g/day; 95% confidence interval, 35.13 to 207.16; P = 0.008) when high energy density feeds were offered. Although the caloric intake from semi-solids increased significantly (18.9 kcal/day; 95% confidence interval, 12.9 to 24.8; P < 0.001) with the high density diet, the total caloric intake (breast milk and study feeds) decreased (mean difference = 59.6 kcal/day; 95% confidence interval, 5.95 to 113.34; P = 0.031). An inverse relationship was found between caloric density of semi-solids and breast milk intake (r = 0.34, r = 0.12, P = 0.032). CONCLUSION: In the short term, oil supplementation of complementary food in breastfed infants does not translate into enhanced total caloric intake, primarily as a result of breast milk displacement.

Breast Feeding↗

PubMed2004

Controlling iron deficiency anemia through the use of home-fortified complementary foods.

Iron deficiency anemia (IDA) is more common in South Asian countries including India, Bangladesh and Pakistan than anywhere else in the world. During infancy and early childhood, IDA is associated with impaired psycho-motor development and cognitive function that may be irreversible. As a consequence, there is a growing awareness that IDA is one of many factors impeding socio-economic prosperity of developing nations. The combination of unacceptably high prevalence rates and inadequate preventative programs highlights the need for new effective sustainable strategies to control IDA. The burden of iron deficiency can be reduced by taking a more holistic approach that would include promotion of healthy weaning practices and use of appropriate complementary foods, together with improving the nutritional value of such foods. There is an increasing body of peer-reviewed literature to support the contention that "micronutrient Sprinkles" is an effective strategy to improve the nutritional value of home-prepared complementary foods and thus to reduce the burden of iron deficiency among children. By combining data from recently conducted randomised control trials, Sprinkles were shown to be as efficacious as iron drops for treating childhood anemia. The iron in Sprinkles is well absorbed, and Sprinkles are easy to use and well accepted by young children and their caregivers. Integrated into existing public health programs, Sprinkles has the potential to improve the effectiveness of such programs.

Age Distribution↗

PubMed2003

B vitamins: proposed fortification levels for complementary foods for young children.

The B vitamins, except for folate, can be classified as group I nutrients during lactation. Nutrients in this category share the following characteristics: low maternal intake or stores during lactation reduce the concentration in human milk, and infants' stores are readily depleted. For some of these nutrients, the infants' stores at birth may be depleted by maternal deficiency during pregnancy. The prevalence of some B vitamin deficiencies, especially deficiencies of riboflavin and vitamin B-12, is probably much higher than is usually assumed. Taken together, these considerations emphasize the importance of supplying adequate amounts of B vitamins to infants and young children. Recommendations are made here on the amounts and densities of B vitamins that should be present in fortified complementary foods fed to children aged 6-24 mo. The values are based on the difference between recommended daily intakes and the amount that the child will receive from maternal milk using estimates reported in the literature. There are few concerns about the potential toxicity of any of these vitamins at the levels likely to be added to complementary foods. If there are losses during food preparation or concentrations of the vitamins are low in human milk, the estimates provided may need to be increased. The adequacy of these recommendations must be evaluated thoroughly.

Diet↗

PubMed1999

Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras.

BACKGROUND: The optimal age at which to introduce complementary foods is a topic of considerable debate. OBJECTIVE: This study was designed to evaluate this issue in a nutritionally vulnerable population in Honduras. DESIGN: Mothers of low-birth-weight (1500-2500 g) term (ie, small-for-gestational-age) infants were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, mothers were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or to feed complementary solid foods (jarred rice cereal, chicken, and fruit and vegetables) twice daily from 4 to 6 mo while continuing to breast-feed at their initial frequency (SF; n = 60). At 4 and 6 mo, breast milk and total energy intake were measured for a nonrandom subsample (those who could stay overnight in a central unit: 32 EBF and 31 SF). RESULTS: At 4 mo, breast milk intake in the subsample was not significantly different between groups (EBF: 729 +/- 135 g/d; SF: 683 +/- 151 g/d: P >0.2); from 4 to 6 mo it increased (by 28 g/d) in the EBF group but decreased (by 39 g/d) in the SF group (P < 0.005). Nonetheless, total energy intake (including solid foods) increased more from 4 to 6 mo in the SF than in the EBF group. However, there were no significant differences between groups in weight or length gain during the intervention or subsequently (6-12 mo). CONCLUSION: There was no growth advantage of complementary feeding of small-for-gestational-age, breast-fed infants between 4 and 6 mo of age.

Adult↗

PubMed2000

Chemical evaluation of multimixes formulated from some local staples for use as complementary foods in Nigeria.

The nutrient compositions of eight multimixes formulated for use as complementary foods from processed soybeans, cowpeas, maize, sorghum, yams, cocoyams, plantains and sweet potatoes were examined. The foods were processed by sprouting, cooking and fermentation. The samples were separately dried and milled to fine flours. A ratio of 65% cereal, 30% legume and 5% starchy staple (65:30:5) calculated on a protein basis was used to formulate the multimixes. The blends were chemically analyzed using standard procedures. The mixtures containing soybeans had higher protein, lipid, energy, crude fiber and calcium levels but lower carbohydrate content than those mixtures without soybean. The protein and energy levels of the multimixes were higher than those of some commercial infant foods (Cerelac, Farex and Nestrum) in Nigeria but were comparable to that of 'soy-ogi'. The multimixes contained fair quantities of calcium and phosphorus and an adequate amount of some of the essential amino acids. Methionine was the most limiting amino acid in all the mixtures. Blending cowpeas with maize produced a higher protein score than blending cowpeas or soybeans with sorghum. The cowpea/maize/sweet potato mixture had the highest protein score.

Dietary Carbohydrates↗

PubMed2004

[Effect of complementary food supplements on anemia in infant and young children].

OBJECTIVE: To investigate the effect of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infant and young children. METHODS: In 5 poor county of Gansu province, children aged 4-12 months were enrolled and divided into two groups, protein and micronutrient were supplemented in Formula I group, all children were observed until they were 24 months old. Every 6 months, a massive dose of Vitamin A was supplemented to all children, hemoglobin tests were done at the same time. RESULTS: At baseline survey, there are no differences in hemoglobin and prevalence of anemia between two groups. During the follow-up of 12 months supplementation, Hemoglobin increase of the Formula I group is significantly higher than Formula II group(P < 0.0005), prevalence of anemia reduce obviously and there is statistically different between the two groups. Hemoglobin increase of the two groups are significantly different until all children are 24 months old(P = 0.006). CONCLUSION: Supplemented micronutrient and large-dose Vitamin A can increase hemoglobin and decrease prevalence of anemia in infant and young children.

Anemia, Iron-Deficiency↗

PubMed2004

Donated fortified cereal blends improve the nutrient density of traditional complementary foods in Haiti, but iron and zinc gaps remain for infants.

This research assesses whether fortified cereal blends such as corn-soy blend (CSB) or wheat-soy (WSB) blend can significantly contribute to improving the quality of the diet of infants and young children 6 to 23 months of age. A series of participatory recipe trials was conducted to assess current complementary feeding practices in the Central Plateau of Haiti and to develop new, improved recipes by using a combination of locally available ingredients and foods and donated fortified cereal blends. Our findings show that it is feasible to improve the nutritional quality of complementary foods in poor rural areas of Haiti, using locally available ingredients and fortified cereal blends. Significant improvements in the concentrations of vitamin A could be obtained by including acceptable and affordable amounts of locally available vitamin A-rich foods such as pumpkin or eggs. Only preparations using CSB, however, could achieve the recommended concentrations of iron and zinc in complementary foods, and even this was achievable only for 12- to 23-month-old children. For infants, and especially those between 6 and 8 months of age, the high requirements of 7.7 mg of iron and 1.6 mg of zinc per 100 kcal of complementary foods could not be met, even with a combination of fortified CSB and other locally available, acceptable, and affordable foods. The same was true for the zinc density of complementary foods among 9- to 11-month-old children, which could not be achieved even with fortified CSB. Thus, in this population, fortified cereal blends were key to achieving the recommended iron and zinc densities of complementary foods for children 12 to 23 months of age, but they were not sufficient for infants. Complementary approaches, such as improving the availability, access, and intake of animal-source foods or the use of home fortification techniques (using spreads, sprinkles, or dispersible tablets), are needed to ensure adequate iron and zinc density of complementary foods for infants younger than 12 months in resource-constrained environments such as rural Haiti.

Edible Grain↗

PubMed2005

Vinegar and peanut products as complementary foods to reduce postprandial glycemia.

Mealtime glycemic load is associated with risk for chronic disease. This study examined whether complementary foods (vinegar and peanut products) could lower postprandial glycemia without altering mealtime glycemic load. Eleven healthy subjects consumed two test meals (bagel and juice, glycemic load=81; or chicken and rice, glycemic load=48) under three conditions (control, vinegar, or peanut) using a randomized, crossover design. Vinegar or peanut ingestion reduced the 60-minute glucose response to both test meals by approximately 55%, but these reductions were significant only for the high-glycemic load meal. After consumption of the high-glycemic load meal, energy consumption for the remainder of the day was weakly affected by the vinegar and peanut treatments, a reduction of approximately 200 to 275 kcal (P=.111). Regression analyses indicated that 60-minute glucose response to the test meals explained 11% to 16% of the variation in later energy consumption. In conclusion, the addition of vinegar or peanut products to a high-glycemic load meal significantly reduced postprandial glycemia.

Acetic Acid↗

PubMed2001

Critical control points of complementary food preparation and handling in eastern Nigeria.

OBJECTIVE: To investigate microbial contamination and critical control points (CCPs) in the preparation and handling of complementary foods in 120 households in Imo state, Nigeria. METHODS: The Hazard Analysis Critical Control Point (HACCP) approach was used to investigate processes and procedures that contributed to microbial contamination, growth and survival, and to identify points where controls could be applied to prevent or eliminate these microbiological hazards or reduce them to acceptable levels. Food samples were collected and tested microbiologically at different stages of preparation and handling. FINDINGS: During cooking, all foods attained temperatures capable of destroying vegetative forms of food-borne pathogens. However, the risk of contamination increased by storage of food at ambient temperature, by using insufficiently high temperatures to reheat the food, and by adding contaminated ingredients such as dried ground crayfish and soybean powder at stages where no further heat treatment was applied. The purchasing of contaminated raw foodstuffs and ingredients, particularly raw akamu, from vendors in open markets is also a CCP. CONCLUSION: Although an unsafe environment poses many hazards for children's food, the hygienic quality of prepared food can be assured if basic food safety principles are observed. When many factors contribute to food contamination, identification of CCPs becomes particularly important and can facilitate appropriate targeting of resources and prevention efforts.

Child↗

PubMed2006

Effects of varied energy density of complementary foods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children.

BACKGROUND: Information is needed to design studies of the effects of complementary feeding regimens on children's intakes of complementary foods (CFs) and breast milk. OBJECTIVE: We evaluated the effects of varied energy density of CFs on the time until stabilization of dietary intakes and on total daily energy intakes (EIs) and breast-milk intakes. DESIGN: CFs with low [0.4 kcal/g (LD)] and high [1.5 kcal/g (HD)] energy density were fed 3 times/d to 10 children (aged 9-18 mo) during 2 randomly assigned sequences of three 8-d diet periods (HD-LD-HD or LD-HD-LD) along with ad libitum breastfeeding. CF and breast-milk intakes were measured. RESULTS: Intakes of the HD diet and breast milk did not vary by day of period, but intake of the LD diet increased progressively. During days 5-7 of the last 2 diet periods in each sequence, more of the LD than of the HD diet was consumed (752 +/- 252 and 439 +/- 111 g/d, respectively; P < 0.001), but EIs from CFs were greater with the HD diet. Breast-milk consumption was slightly less (192 +/- 115 and 234 +/- 121 g/d, respectively; P = 0.03) but total daily EI was greater (774 +/- 175 and 441 +/- 85 kcal/d, respectively; P < 0.001) during the HD than during the LD diet period. CONCLUSIONS: New information on the effects of newly introduced diets on daily intakes of these diets and of breast milk can be used to design future studies. Total daily EIs were greater with the HD diet despite its negative effects on breast-milk intakes.

Adaptation, Physiological↗

PubMedDate not supplied

Risk factors for early interruption of exclusive breastfeeding and late introduction of complementary foods among infants in midwestern Brazil.

OBJECTIVE: To identify factors associated with early interruption (before 4 months) of exclusive breastfeeding and late introduction (after 8 months) of complementary foods. METHODS: This is a cross-sectional study, based on a survey conducted on the first day of the National Vaccination Campaign in 2004, in Cuiabá, MT, Brazil. The sample comprised 921 children less than 1 year old, and the adult accompanying each child was interviewed and a semi-structured questionnaire filled out. Probit analysis was employed to assess consumption of liquids and solids, and logistic regression analysis was applied to identify factors associated with early introduction of liquids and with late introduction of solids. RESULTS: There was elevated consumption of water and teas, followed by cow's milk among those less than 120 days old. Children were more likely to be given liquids on the day of the survey if they had been consuming them on the day they were discharged from the maternity unit. Approximately 60% of the children were being given soup or the family meal by 8 months. CONCLUSIONS: Liquids being given on the first day at home was a good predictor that they would be given for the first 4 months, emphasizing the need for intervention during prenatal care and at maternity units to counter the harm caused by this practice. After 8 months, however, it is necessary to emphasize the importance of the child participating in family meals, especially for adult mothers without higher education and primaparous mothers.

Adult↗

PubMed1997

Age at introduction of complementary food and physical growth from 2 to 9 months in rural Senegal.

OBJECTIVE: To compare nutritional status and physical growth among infants according to age at introduction of complementary food (CF). DESIGN: A longitudinal observational study. SETTING: Three health clinics in a rural area of Senegal. SUBJECTS: During immunization sessions, 522 infants were recruited at 2-3 months. Complete data on three visits were available for 420 infants (4 visits: n = 361); 73 were lost to follow-up and 29 had incomplete data. MAIN OUTCOME MEASURES: Increments in length and weight between adjacent visits. RESULTS: Infants complemented at 2-3 months (n = 50) had significantly lower length-for-age (P = 0.014), weight-for-length (P < 0.001) and arm circumference (P < 0.0001) at 2-3 months than predominantly breastfed infants (n = 370), after adjustment for residence, mother's age and education of parents. The growth in weight and length from 2-3 to 9-10 months did not differ. The infants complemented by 4-5 months, but not yet at 2-3 months, (n = 94) had a slightly lower length increment from 4-5 to 6-7 months (1.42 vs 1.53 cm/mo, p < 0.05) compared to infants predominantly breastfed at 4-5 months (n = 276). The infants first complemented by 6-7 months (n = 122) had increments from 6-7 to 9-10 months similar to those of predominantly breastfed infants (n = 154). CONCLUSION: Introduction of CF by 2-3 months was associated with a low nutritional status, but not with slow growth from 2-3 to 9-10 months. Introduction of CF by 4-5 months was associated with slightly slower linear growth compared to later introduction.

Age Factors↗

PubMed2006

Iron solubility compared with in vitro digestion-Caco-2 cell culture method for the assessment of iron bioavailability in a processed and unprocessed complementary food for Tanzanian infants (6-12 months).

The Fe solubility test is a commonly used, easy and relatively cheap in vitro tool for predicting Fe bioavailability in food matrices. However, the outcome of a recent field trial comparing the effect on Fe status of Tanzanian infants of processed v. unprocessed complementary foods (CF), with otherwise the same composition, challenged the validity of this test for predicting Fe bioavailability. In the solubility test, significant more soluble Fe was observed in processed compared with unprocessed foods (mean 18.8 (sem 0.21) v. 4.8 (sem 0.23) %; P<0.001). However, in the field trial, no significant difference in Fe status was seen between processed and unprocessed CF groups after 6 months' follow-up. Therefore, twenty-four samples of these CF (twelve processed and twelve unprocessed batches) were analysed in triplicate for Fe availability using an in vitro digestion-Caco-2 cell culture method and results were compared with solubility results. Significantly more soluble Fe was presented to Caco-2 cells in the processed compared with unprocessed samples (mean 11.5 (sem 1.16) v. 8.5 (sem 2.54) %; P=0.028), but proportionally less Fe was taken up by the cells (mean 3.0 (sem 0.40) v. 11.7 (sem 2.22) %; P=0.007). As a net result, absolute Fe uptake was lower (not significantly) in processed compared with unprocessed CF (mean 1.3 (sem 0.16) v. 3.4 (sem 0.83) nmol/mg cell protein; P=0.052). These data clearly demonstrate that the Fe solubility test was not a good indicator of Fe bioavailability in these particular food matrices. In contrast, the results of an in vitro Caco-2 model supported the effects observed in vivo.

Biological Availability↗

PubMed2002

Evaluation of the nutritional characteristics of a finger millet based complementary food.

Finger millet (Eleusine coracana), kidney beans (Phaseolus vulgaris), peanuts (Arachis hypogoea), and mango (Mangifera indica) were processed separately and then combined, on the basis of their amino acid scores and energy content, into a complementary food for children of weaning age. The finger millet and kidney beans were processed by germination, autoclaving, and lactic acid fermentation. A mixture containing, on a dry matter basis, 65.2, 19.1, 8.0, and 7.7% of the processed finger millet, kidney beans, peanuts, and mango, respectively, gave a composite protein with an in vitro protein digestibility of 90.2% and an amino acid chemical score of 0.84. This mixture had an energy density of 16.3 kJ.g(-1) of dry matter and a decreased antinutrient content and showed a measurable improvement in the in vitro extractability for calcium, iron, and zinc. A 33% (w/v) pap made from a mix of the processed ingredients had an energy density of 5.4 kJ.g(-1) of pap, which is sufficient to meet the energy requirements of well-nourished children of 6-24 months of age at three servings a day and at the FAO average breast-feeding frequency.

Amino Acids↗

PubMed2002

Effect of an integrated child nutrition intervention on the complementary food intake of young children in rural north Viet Nam.

Forty-two percent of Vietnamese children are stunted by two years of age. Since 1990, Save the Children Federation/US (SC) has implemented integrated nutrition programs targeting young children. We evaluated the effect of SC's nutrition program on the complementary food intake of young rural Vietnamese children. Using a longitudinal, prospective, randomized design, we followed 238 children (119 each from intervention and comparison communes) age 5 to 25 months old for six months with a re-survey at 12 months. We gathered 24-hour recall data at baseline and at months 2, 4, 6, and 12. Dietary energy intake was calculated using the 1972 Vietnamese food composition table. Key outcomes were daily frequency of consuming intervention-promoted food and non-breastmilk liquids and food, daily quantity of non-breastmilk liquids and food consumed, daily energy intake, and proportion of children meeting daily median energy requirements. Young rural children exposed to SC's program consumed intervention-promoted, and any, foods more frequently, ate a greater quantity of any food, consumed more energy, and were more likely to meet their daily energy requirements than comparison children. Some effects were only observed during the intensive intervention period; others persisted into or were evident only at the 12-month follow-up, approximately four months after program completion. Based on the mothers' reports, the intervention did not apparently compromise breastfeeding prevalence or frequency. The intervention improved children's food and energy intake and protected them from declining as rapidly as comparison children in meeting their energy requirements.

Breast Feeding↗