Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study

Background

In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)‐free protein substitute (PS) to help meet non‐Phe protein requirements. Semi‐solid weaning Phe‐free PS have been available for >15 years, although no long‐term studies have reported their efficacy.

Methods

Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe‐free infant L‐amino acid formula; natural protein intake; and issues with administration of PS or food.

Results

Median commencement age for weaning was 17 weeks (range 12–25 weeks) and, for weaning PS, 20 weeks (range 13–37 weeks). Median natural protein was 4 g day^?1 (range 3–11 g day^?1) and total protein intake was >2 g kg^?1 day^?1 from weaning to 2 years of age. Children started on 2–4 g day^?1 protein equivalent (5–10 g day^?1 of powder) from weaning PS, increasing by 0.2 g kg^?1 day^?1 (2 g day^?1) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02).

Conclusions

Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.

     

A retrospective analysis of synthetic protein prescription in Irish children with phenylketonuria

Background: Phenylketonuria (PKU) is an inherited inborn error of metabolism resulting in the inability of the patient to metabolise the essential amino acid (AA) phenylalanine (Phe) and convert it to tyrosine. Untreated, a build‐up of Phe occurs that damages the brain and leads to mental retardation (Williams et al., 2008). Management guidelines for the treatment of the disorder by the Medical Research Council (MRC) make recommendations on the quantity of AA substitute to be provided and the desired ranges for Phe levels. The aim of this study was to address the hypothesis that children consuming less than recommendation for synthetic AA intake can grow normally and achieve good biochemical control. Methods: Patients with moderate to classical hyperphenylalaninaemia born between the 1 January 1998 and December 2008 were retrospectively identified from the patient database of the National Centre for Inherited Metabolic Disorders for inclusion in the study. Anthropometric data and protein intake data were collected from medical records of 121 patients from birth to the age of 2 years, at six specific time‐points. From these data, exact weight/height centiles and change in centile z‐scores were calculated. Intakes (g kg^?1) of synthetic AAs and natural protein were calculated at each time‐point based on protein intake reported by parents and noted in dietetic notes. The cohort was split into groups based on synthetic AA intake: ≥ 3g kg^?1day^?1, representing those meeting the MRC guidelines, 1.5–1.99 g kg^?1 day^?1 and 2–2.5 g kg^?1 day^?1. These groups were then statistically compared in terms of growth parameters and biochemical control using Student's t‐tests and Mann–Whitney U‐tests depending on data distribution. Results: At 2 years, subjects in the groups achieving lower than the recommended synthetic AA intake displayed a significantly smaller decrease in the change in z‐score for height (P = 0.001 for 2–2.5 g kg^?1 group, P = 0.034 for 1.5–1.99g kg^?1 group compared to ≥3 g kg^?1 day^?1) and weight (P = 0.006 for 2–2.5 g kg^?1 group compared to ≥3 g kg^?1 day^?1), indicating that they had less of a growth deficit compared to those meeting the AA intake guideline. Mean blood Phe levels over the time‐points investigated were also significantly lower in the groups consuming less than the MRC guideline. Discussion: This study has shown that the growth deficit is less in patients consuming decreased amounts of synthetic protein. Schaefer et al. (1994) found no correlation between Phe intake and the rates of growth, although they did not analyse the effect of synthetic protein intake on these parameters. In the current study, significant negative correlations were found between change in weight and height centile z‐scores and synthetic AA intake at 2 years. This negative correlation was upheld, even when the confounding effect of natural protein intake was controlled for. These results are contrary to previously published studies showing no correlation between protein intake and growth retardation (Weglage et al., 1994; Dobbelaere et al., 2003). As with the study by Schaefer et al. (1994), these studies did not analyse the two separate fractions of protein that PKU patients consume (i.e. natural and synthetic). These results support the hypothesis that children can achieve adequate growth and biochemical control at synthetic AA intakes below the MRC recommendation. Conclusions: This study provides a base upon which prospective studies should be designed to determine a more appropriate synthetic AA intake recommendation for children with PKU. References: Dobbelaere, D., Michaud, L., Debrabander, A., Vanderbecken, S., Gottrand, F., Turck, D. et al. (2003) Evaluation of nutritional status and pathophysiology of growth retardation in patients with phenylketonuria. J. Inherit. Metab. Dis. 26 , 1–11. MRC (1993) Recommendations on the dietary management of phenylketonuria. Report of Medical Research Council Working Party on Phenylketonuria. Arch. Dis. Child. 68 , 426–427. Schaefer, F., Burgard, P., Batzler, U., Rupp, A., Schmidt, H., Gilli G., et al. (1994) Growth and skeletal maturation in children with phenylketonuria. Acta Paediatr. 83 , 534–541. Weglage, J., Bramswig, J.H., Koch, H.G., Karassalidou, S. and Ullrich, K. (1994) Growth in patients with phenylketonuria. Eur. J. Pediatr. 153 , 537–538. Williams, R., Mamotte, C., Burnett, J. (2008) Phenylketonuria: an inborn error of phenylalanine metabolism. Clin. Biochem. Rev. 29 , 31–41. Yi, S. and Singh, R. (2008) Protein substitute for children and adults with phenylketonuria. Cochrane Database Syst. Rev.CD004731.     

Magnesium balance studies in premature and term infants

Summary Background: The knowledge of magnesium requirements of premature infants is still very limited, although it is essential for the optimal composition of suitable formulas. Aim of the study: The study concept was 1) to assess physiological magnesium balance data of healthy term infants and longitudinal results from formula-fed premature infants and 2) to deduce conclusions on the magnesium content of the formulas. Methods: Premature infants (n = 14, birth weight ≤ 1500 g, gestational age ≤ 32 weeks) were studied in conventional balance trials with 1) a semi-elemental diet (A), 2) preterm infant formula (B), and 3) infant formula (C). In addition, healthy term formula-fed (n = 11, D) and breast-fed (n = 14, E) infants were investigated. Analysis was performed by flame atomic absorption spectroscopy. Results: The median magnesium intake ranged between 4.84 mg/kg × d⁻¹ (breast-fed infants) and 16.33 mg/kg × d⁻¹ (premature infants). The term breast-fed infants retained nearly as much magnesium as term formula-fed infants (3.37 vs. 3.97 mg/kg × d⁻¹), due to a low percental fecal and urinary excretion. A higher magnesium retention was observed in the premature group: A: 7.97 mg/kg × d⁻¹, B. 5.3 mg/kg × d⁻¹, 3.) 5.54 mg/kg × d⁻¹. Conclusion: In view of the high percental magnesium retention in formula-fed premature infants, excessive supply should be avoided. The long-term effects of lower intakes have to be monitored. Received: 23 July 1999, Accepted: 2 February 2000     

Changes in serum phenylalanine after overnight fasts in youngsters with phenylketonuria

Background and aims: In patients with phenylketonuria (PKU), overnight fasting is associated with rises in serum phenylalanine (PHE) concentration. This is thought to result from catabolism of endogenous protein, which can be reduced by a bedtime snack accompanied by a dose of PHE-free protein substitute (P/S). This study assessed the effectiveness of this strategy and whether any additional benefit was conferred by omitting PHE from the bedtime snack. Methods: Data are presented for 18 PKU children (aged 9–16 years), studied over a 48-h period whilst following diets of known composition. All the subjects had a bedtime snack accompanied by 25% of their P/S daily requirement. Half the subjects (Group X) had 25% of their daily PHE allowance in the bedtime snack, whilst the others (Group Z) ate only ‘PHE-free’ foods at this time. Results: Overnight changes in serum PHE levels were generally small for both groups; the mean serum PHE level changed very little overnight (Group X: 405 μmol L^?1 post snack, 389 μmol L^?1 prebreakfast; Group Z: 430 μmol L^?1 post snack, 426 μmol L^?1 pre breakfast). Conclusion: Overnight changes in serum PHE levels can be minimized by a bedtime snack accompanied by a proportion of the daily protein substitute. Omission of PHE from the snack confers no extra advantage.     

Impact of Maternal Infant Weight Perception on Infant Feeding and Dietary Intake

Introduction Obesity is a global problem that is challenging to prevent and expensive to treat. Early childhood interventions show promise in establishing lifelong healthy eating patterns, however a better understanding of how parental feeding practices develop is needed. The study aimed to investigate maternal perception of infant weight and its relationship to feeding practices and infant dietary intake. Methods A questionnaire was completed by 263 Queensland mothers of infants aged between 5 and 13 months. Logistic regression was used to describe the association between maternal feeding practices (restriction, pressure-to-eat, monitoring), parenting style (warmth, hostility), infant weight concern and infant dietary intake. Correlation and linear regression were used to identify relationships between maternal feeding practices, parenting style, infant weight concern and infant weight. Results Mothers were found to be more concerned about underweight than overweight, misjudge infants as being underweight and failed to recognise overweight infants. Underweight concern was associated with infant weight (r?=??0.27, p?<?0.01), early introduction of solids (OR 0.24, CI 0.11–0.51) and pressure-to-eat (r?=?0.19, p?<?0.01). Pressure-to-eat was associated to maternal perception of infant weight (r?=???0.21, p?<?0.01), infant weight (r?=???0.17, p?<?0.05) and lower fruit and vegetable intake (OR 0.50, CI 0.27–0.92). Restrictive feeding practices were correlated to overweight concern (r?=?0.08, p?<?0.05). Discussion Maternal infant weight perception and concerns are related to control feeding practices which can be detrimental to infant dietary intake. Inability to recognise healthy weight may ignite these concerns or fail to address infant feeding risk factors. Discussing healthy growth should be a fundamental component of strategies to support healthy infant feeding and eating.     

Parenteral nutrition in a premature infant with phenylketonuria

Parenteral nutrition (PN) is now an important facet of the management of the extremely premature infant. However, its effects on those with inherited metabolic disease have not been well documented. We report an infant with classical phenylketonuria (PKU) who had unusually high serum phenylalanine at 12 days of life (5200 mumol; greater than 3.2 SD above our mean for PKU at 10-15 days of age) while on parenteral nutrition, despite a relatively high tolerance for phenylalanine on oral feeds at 3-4 months of life (97-128 mg/kg/day; normal for PKU: less than 90 mg/kg/day). Identification of PKU was somewhat delayed in this child because of failure to recognize that parenteral nutrition provides a phenylalanine load equivalent to or greater than the routine oral formula feeding. Despite the high levels of phenylalanine in the first 2 wk of life, mental and motor development are normal at 16 months of age. This case, the first such reported, suggests the parenteral nutrition in the premature PKU infant is relatively safe, but draws attention to the possible need for phenylalanine-free amino acid infusates for those who require long-term treatment.     

Diet and the growth of healthy infants*

This paper reviews published work on the patterns of infant growth in Cambridge, UK and in Gambia, West Africa and other countries. Growth patterns are related to patterns of infant feeding and compared with currently accepted growth standards, namely the ‘Tannerl Revised Standards, 1975’ and the NCHS Standards. It is concluded that these standards, derived from predominantly bottle-fed infants, may be inappropriate for breast-fed infants and may lead to unnecessary anxiety on the part of health workers and mothers when breast-fed babies cross ‘standard’ growth centiles.     

Serum T4 level in term newborns: Comparison between breast-fed and formula-fed infants

Serum thyroxine measurement ([¹²⁵I] T₄-RIA) was performed on the third day of life in 1759 normal, full-term infants. The T₄ concentrations were similar in the 680 formula-fed infants (16.32±0.09 μg/dl) and in the 1079 breast-fed infants (16.46±0.08 μg/dl). A male breast-fed infant was discovered to have hypo-TBG-emia. Our findings show that breast feeding from birth will not interfere with neonatal screening for hypothyroxinemia on the third day of life. Additionally, the mean T₄ value in the formulafed males was significantly lower than the breast-fed males, (15.88±0.13 μg/dl vs 16.32±0.11 μg/dl, p<0.01). Also, the formula-fed males has a significantly lower (p<0.01) T₄ concentration when compared with the formula-fed females.     

Infant food marketing strategies undermine effective regulation of breast‐milk substitutes: trends in print advertising in Australia, 1950–2010

Objective : This study addresses the issue of whether voluntary industry regulation has altered companies’ marketing of breast‐milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast‐milk Substitutes 1981. Methods : Print advertisements marketing breast‐milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. Results : Breast‐milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975–79, other breast‐milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. Conclusions : Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. Implications : Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia.     

Early infant feeding and growth status of US-born infants and children aged 4-71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988-1994

BACKGROUND: There is controversy over what growth references to use in evaluating breast-fed infants and concern about whether never-breast-fed infants are at risk of overweight in childhood. OBJECTIVE: The objective of this study was to determine whether infants who are exclusively breast-fed for 4 mo differ in average size from infants who are fed in other ways and whether such differences persist through age 5 y. DESIGN: Data from the third National Health and Nutrition Examination Survey (NHANES III) were linked to birth certificates of US-born infants and children. Feeding groups were defined on the basis of feeding patterns over the first 4 mo of life: exclusively breast-fed for 4 mo, partially breast-fed, breast-fed for <4 mo, and never breast-fed. Growth status, indexed as internally derived z scores (SD units) for weight, length (height), weight-for-length (height), midupper arm circumference, and triceps skinfold thickness, was compared among feeding groups. RESULTS: The final sample consisted of 5594 non-Hispanic white, non-Hispanic black, and Mexican American infants and children aged 4-71 mo. Of these, 21% were exclusively breast-fed for 4 mo, 10% were partially breast-fed, 24% were breast-fed for <4 mo, and 45% were never breast-fed. At 8-11 mo, infants who were exclusively breast-fed for4 mo had adjusted mean z scores for weight (-0.21; -0.2 kg), weight-for-length (-0.27), and midupper arm circumference (-0.15) that differed significantly from zero (P < 0. 05). By 12-23 mo, the differences had dissipated; there were no significant differences subsequent to 5 y. Triceps skinfold thickness was not related to early infant feeding. CONCLUSION: Infants who were exclusively breast-fed for 4 mo weighed less at 8-11 mo than did infants who were fed in other ways, but there were few other significant differences in growth status through age 5 y associated with early infant feeding.     

Breast feeding during the first few days after birth: sometimes insufficient

Two newborn infants that were receiving breast-feeding were admitted to hospital for drowsiness and jaundice on the 6th and 4th day of life, respectively; these were a male infant that had been yellow since the very first day and a female infant that did not grasp the breast properly. Both recovered thanks to phototherapy and the administration of extra fluids. Seven days after discharge, the female infant was readmitted for the same symptoms, after which the breast-feeding was found to be insufficient and the infant was put on bottle-feeding. In infants that are being breast-fed, insufficient intake can result in dehydration with all of its consequences. Such insufficient intake may be difficult to recognise. Weight loss greater than 5% implies that more frequent feeding is necessary and a loss of more than 10% may mean that supplementary feeding is necessary, albeit temporarily.     

Protein intake, growth and lung function of infants with chronic lung disease

Background: The increased survival rate of extremely preterm infants has not improved the incidence or outcome of infants diagnosed with chronic lung disease (CLD) (Riley, 2008). The relationship between optimal nutrition (particularly protein intake) and chronic lung disease has not been established. The aim of this study was to investigate the association between protein intake, growth and lung function in infants with CLD. Methods: A CLD database, maintained for the past 10 years, was used to select participants that had reached 1 year of corrected age. Infants who were born during 2001–2006 with a birth weight of <1500 g, and who subsequently had a diagnosis of CLD, were included. Infants with evidence of intra‐uterine growth restriction and abnormal cerebral pathology were excluded. Demographic, mean weight gain, protein intake and respiratory support data were collected retrospectively from the medical notes. Growth parameters and need for oxygen and inhalers up to 1 year of corrected age were collected from the CLD follow‐up database. SPSS, version 15 (SPSS Inc., Chicago, IL, USA) were used for Pearson's or Spearmans correlation analysis and analysis of variance or the Wilcoxon test, as appropriate. Results: Sixty infants were studied: 25 females and 35 males. The median (range) post‐menstrual age at birth was 26 (22–31) weeks. The most common feed was breast milk; fortified breast milk was used for 37% of the total days studied. The mean (SD) protein intake was 2.28 (0.33) g kg^?1 day^?1 and the mean (SD) weight gain was 11.67 (1.77) g kg^?1 day^?1. There was a positive correlation between protein intake and weight gain (r = 0.32, P = 0.013), which was stronger in females (r = 0.51, P = 0.009). Protein intake was significantly associated with head circumference growth in females only (r = 0.47, P = 0.038). Protein intake was inversely related to the number of days spent mechanically ventilated (r = ?0.32, P = 0.015). There was no relationship between protein intake and growth at 1 year corrected age, time spent on continuous positive airway pressure, age weaned off oxygen, or the use of inhalers. There was an inverse correlation between total weeks of oxygen dependence and head circumference at 1 year (r = ?0.35, P = 0.022). Discussion: The mean protein intake was <3 g kg^?1 day^?1, which is the minimum requirement for preterm infants (Tsang et al., 2005). This was associated with a sub‐optimal weight gain in our participants of <15 g kg^?1 day^?1 (Steward & Pridham, 2002). The study demonstrates the known association between low protein intake and poor growth with ventilator dependence (Loui et al., 2008). Conclusions: Low birth weight and low gestational age infants at risk of CLD should receive special attention to optimise their protein intake because sub‐optimal protein intake potentially leads to poor growth when on a neonatal intensive care unit. References Loui, A., Tsalikaki, E., Maier, K., Walch, E., Kamarianakis, Y. & Obladen, M. (2008) Growth in high risk infants <1500 g birth weight during the first 5 weeks. Early Hum. Dev. 84 , 645–650, Doi: 10.1016/j.earlhumdev.2008.04.005 . Riley, K., Roth, S., Sellwood, M. & Wyatt, J.S. (2008) Survival and neurodevelopmental morbidity at 1 year of age following extremely preterm delivery over a 20‐year period: a single centre cohort study. Acta Paediatr. 97 , 159–165. Steward, D.K. & Pridham, K.F. (2002) Growth patterns of extremely low‐birth‐weight hospitalised preterm infants. JOGN Nurs 31 , 57–65. Tsang, R.C., Uauy, R., Koletzko, B. & Zlotkin, S.H., eds. (2005) Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. Cincinnati: Digital Educational Publishing.     

Dietetic Management of Adults with Phenylketonuria (PKU) in the UK: A Care Consensus Document

There is an increasing number of adults and elderly patients with phenylketonuria (PKU) who are either early, late treated, or untreated. The principal treatment is a phenylalanine-restricted diet. There is no established UK training for dietitians who work with adults within the specialty of Inherited Metabolic Disorders (IMDs), including PKU. To address this, a group of experienced dietitians specializing in IMDs created a standard operating procedure (SOP) on the dietetic management of adults with PKU to promote equity of care in IMD dietetic services and to support service provision across the UK. The group met virtually over a period of 12 months until they reached 100% consensus on the SOP content. Areas of limited evidence included optimal blood phenylalanine reporting times to patients, protein requirements in older adults, management of weight and obesity, and management of disordered eating and eating disorders. The SOP does not include guidance on maternal PKU management. The SOP can be used as a tool for training dietitians new to the specialty and to raise the standard of education and care for patients with PKU in the UK.     

Earlier appearance of the ossification center of the femoral head in breast-fed versus formula-fed infants

ObjectiveThe aim of this study was to evaluate possible differences in the rate of appearance of the femoral head ossification center (FHOC) in infants according to the type of feeding (exclusive breast-feeding, formula, mixed feeding).MethodsA retrospective study was conducted in a population of 285 healthy infants who consecutively underwent echographic evaluation of the hip as a screening for hip dysplasia from April 1 through October 31, 2008. For each infant, type of feeding, sex, gestational age, weight at birth, and age at the time of echographic examination were recorded. Data analysis was performed in the entire sample population and in a subpopulation of 143 infants after exclusion of preterm or low-birth-weight infants and those who underwent echographic examination outside the scheduled age range. Data were analyzed by chi-square test, Kruskal–Wallis test, and multiple logistic regression analysis.ResultsAn FHOC was present in 48.3% of breast-fed infants, 25.7% of formula-fed infants, and 28% of the mixed feeding group (P = 0.001). In multiple logistic regression analysis, the best regression model included the following variables: age at test (P = 2.23 × 10^?7), gestational age (P = 0.0017), and exclusive breast-feeding (P = 0.0003). Similar results were obtained in the selected subpopulation of 143 infants (FHOC in 54.2% of breast-fed group, 28.2% of formula-fed group, and 33.3% of mixed-feeding group, P = 0.01).ConclusionExclusive breast-feeding may be associated to an earlier appearance of FHOC in a population of normal infants compared with formula feeding.     

Protein Substitutes in PKU; Their Historical Evolution

Protein substitutes developed for phenylketonuria (PKU) are a synthetic source of protein commonly based on L-amino acids. They are essential in the treatment of phenylketonuria (PKU) and other amino acid disorders, allowing the antagonistic amino acid to be removed but with the safe provision of all other amino acids necessary for maintaining normal physiological function. They were first formulated by a chemist and used experimentally on a 2-year-old girl with PKU and their nutritional formulations and design have improved over time. Since 2008, a bioactive macropeptide has been used as a base for protein substitutes in PKU, with potential benefits of improved bone and gut health, nitrogen retention, and blood phenylalanine control. In 2018, animal studies showed that physiomimic technology coating the amino acids with a polymer allows a slow release of amino acids with an improved physiological profile. History has shown that in PKU, the protein substitute’s efficacy is determined by its nutritional profile, amino acid composition, dose, timing, distribution, and an adequate energy intake. Protein substitutes are often given little importance, yet their pharmacological actions and clinical benefit are pivotal when managing PKU.     

Amount and quality of dietary proteins during the first two years of life in relation to NCD risk in adulthood

During late infancy many infants have a protein intake, which is more than three times as high as the physiological need. Several observational studies have shown an association between a high-protein intake (>15 energy %) early in life and an increased risk of developing obesity and thereby non-communicable diseases (NCDs) later in life. This effect was supported by a recent intervention study with infant formulas with two levels of protein, showing that a higher protein intake during the first year of life resulted in a higher body mass index (BMI) at age 2 years. It is also plausible that an important reason for the slower growth in breast-fed infants is the lower content of protein in breastmilk, but other qualities of breastmilk could also play a role. A high intake of protein, especially dairy protein, stimulates the growth factors insulin-like growth factor (IGF-I) and insulin, and it has been suggested that the lower risk of NCDs in breast-fed infants is mediated through a regulation of IGF-I. A low quality of protein, as in cereal-based diets with no animal foods as often seen in low-income countries, may contribute to undernutrition, which can also result in an increased risk of NCDs later in life. In conclusion, there is some evidence that a high protein intake during the complementary feeding period is associated with increased risk of NCDs and that avoidance of a high protein intake could reduce the risk of obesity. In low-income countries, emphasis should be on providing sufficient amounts of high-quality protein to improve survival, growth and development.     

Vegetables by stealth. An exploratory study investigating the introduction of vegetables in the weaning period

Few studies have examined in detail weaning practices and how mothers introduce vegetables into the diets of their infants. The current exploratory study set out to use both qualitative and quantitative methods to investigate approaches to nutrition in the weaning period and in early infancy with a particular focus on vegetables. 75 mothers of infants aged 24-72 weeks filled out a postal questionnaire regarding infant feeding during the weaning period. Mothers completed the infant feeding questionnaire (IFQ) and a food frequency questionnaire (FFQ) to measure familial fruit and vegetable intake. Mothers introduced solid food to their infants at around 20 weeks of age and those who breast-fed their infants tended to introduce solid foods later compared to formula feeding mothers (21 wks versus 17.8 wks, p < 0.05). Infants were offered around 3 different types of vegetable during the first 4 weeks of weaning. 13 mothers then took part in a follow-up in-depth interview. Mothers reported that they relied upon advice from family and friends and their interpretation of cues from their infants indicating the readiness for food, rather than relying on official guidelines. Mothers demonstrated high concern about the nutrient quality of their child's diet and perceived vegetables to be an integral part of the diet. A number of strategies for promoting vegetable intake were identified by mothers, offering vegetables by stealth was one of the most commonly identified strategies.     

The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers’ infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital.     

Fluoride content of powdered infant formula meets Australian Food Safety Standards

Objectives: To identify the fluoride content of powdered formula for infants 0‐12 months in products available from Brisbane stores in 2006/07 and compare this with the fluoride content of infant formula products available in Australia 10 years earlier. Methods: A range of available infant formula powders were collected from major supermarkets and chemists in Brisbane, Queensland. The fluoride levels in infant formula powder samples were determined using a modification of the micro‐diffusion method of Silva and Reynolds 1 utilising perchloric acid and silver sulphate and measured with an ion selective (fluoride) electrode/meter. Fluoride content both prior to and after reconstitution, as well as estimated daily intake according to age was calculated. Results: Formula samples contained an average of 0.49 μg F/g of powder (range 0.24–0.92 μg F/g). After reconstitution with water containing 0mg/L fluoride, the fluoride content averaged 7.09μg F/100mL (range 3.367–22.72 μg F/100mL). Estimated infant fluoride intakes ranged from 0.0039 mg/kg/day for a 6‐12 month old infant when reconstituting milk‐based formula with non‐fluoridated water (0 mg/L), to 0.1735 mg/kg/day for a 0‐3 month old infant when reconstituting soy‐based formula with fluoridated water (1.0 mg/L). Conclusions: Infant formula powders contain lower levels of fluoride than previously found in Australia in 1996. Implications: This confirms that infants consume only a small amount of fluoride from milk‐based powdered infant formula. Although soy‐based infant formulas contain more fluoride than milk‐based products, the levels still comply with national food standards.     

Vitamin B-6 status of breast-fed neonates: influence of pyridoxine supplementation on mothers and neonates.

Vitamin B-6 concentrations in human milk are known to respond rapidly to changes in maternal vitamin B-6 intake. In this study, mothers were supplemented during the first 28 d of lactation with 2 or 27 mg pyridoxine (PN)-HCl/d and a subgroup of breast-fed infants of the 2-mg/d-supplemented mothers were supplemented with 0.4 mg PN-HCl/d. Vitamin B-6 intakes of breast-fed infants reflected the amount of their mother's supplement; intakes were highest for the vitamin-supplemented infants. Vitamin B-6 intake of mothers was a strong indicator of infant vitamin B-6 status. Vitamin intake of infants correlated significantly with five measures of vitamin B-6 status. Plasma pyridoxal-5'-phosphate (PLP) concentrations and birth weight were the strongest predictors of infant growth that were examined. Alkaline phosphatase activity in the mother's milk and infant plasma reflected pyridoxal-PLP ratios in these fluids, suggesting that the enzyme acts in regulating circulating vitamer concentrations.