Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods

We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean +/- SD weight-for-length Z-score = -0.92 +/- 0.88) and moderately stunted (length-for-age Z-score = -1.49 +/- 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (kJ/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk.     

Contribution of complementary food nutrients to estimated total nutrient intakes for urban Guatemalan infants in the second semester of life

Complementary foods (CF) are introduced earlier or later than appropriate in developing societies. They often contribute poorly to overall adequate micronutrient intake during the critical period for growth and development, which constitutes the period from 6 to 12 months of life. The objective of this study was to determine the contribution of the CF nutrients to the total estimated nutrient intake in infants in the second semester of life. Three non-consecutive 24-hour recalls interviews were conducted with mothers of 64 infants, aged 6-12 months on enrolment, from a convenience sample in a marginal urban settlement in Guatemala City. Retrospective recording of early introduction of pre- and post-lacteal feeding and introduction of first foods and beverages was included. Human milk intakes were estimated by a model based on assumptions that human milk plus CF exactly satisfied the infant's daily energy needs. The WHO/FAO Recommended Nutrient Intakes (RNI) were the standards for adequate nutrient consumption. Instances of exclusive breast feeding to 6 months were rare, with the introduction of CF earlier than recommended. Baby food in jars was mentioned most frequently as the first food offered. The contribution of CF increased with age through the second semester of life. CF contributed more of a nutrient than human milk in all instances. However,CF nutrient density for Ca, Fe, and Zn fell below international standard. Fortified sugar contributed excessive amounts of Vitamin A to the diets. We conclude that for most nutrients, intakes reached or exceeded recommendation levels, unusual within the CF experience in scientific literature.     

Breast milk and energy intake in exclusively, predominantly, and partially breast-fed infants

OBJECTIVE: To investigate the extent to which breast milk is replaced by intake of other liquids or foods, and to estimate energy intake of infants defined as exclusively (EBF), predominantly (PBF) and partially breast-fed (PartBF). DESIGN: Cross-sectional. SETTING: Community-based study in urban Pelotas, Southern Brazil. SUBJECTS: A total of 70 infants aged 4 months recruited at birth. MAIN OUTCOME MEASURES: Breast milk intake measured using a "dose-to-the-mother" deuterium-oxide turnover method; feeding pattern and macronutrient intake assessed using a frequency questionnaire. RESULTS: Adjusted mean breast milk intakes were not different between EBF and PBF (EBF, 806 g/day vs PBF, 778 g/day, P=0.59). The difference between EBF and PartBF was significant (PartBF, 603 g/day, P=0.004). Mean intakes of water from supplements were 10 g/day (EBF), 134 g/day (PBF) and 395 g/day (PartBF). Compared to EBF these differences were significant (EBF vs PBF, P=0.005; EBF vs PartBF, P<0.001).The energy intake of infants receiving cow or formula milk (BF+CM/FM) in addition to breast milk tended to be 20% higher than the energy intake of EBF infants (EBF, 347 kJ/kg/day vs BF+CM/FM, 418 kJ/kg/day, P=0.11). CONCLUSIONS: There was no evidence that breast milk was replaced by water, tea or juice in PBF compared to EBF infants. The energy intake in BF+CM/FM infants tended to be 20% above the latest recommendations (1996) for breast-fed and 9% above those for formula-fed infants. If high intakes are maintained, this may result in obesity later in life. SPONSORSHIP: International Atomic Energy Agency through RC 10981/R1.     

乳母营养与乳汁成分分析

本文对240例(城市130例,农村110例)乳母的膳食进行了调查,对城市113份和农村109份母乳进行了成分分析;同时对泌乳量和哺乳婴儿体重也进行了调查。结果表明,乳母热能日摄入量绝大多数在2700kcal以上;蛋白质的摄入量城市在90g以上,且优质蛋白质比例高,农村蛋白质摄入量及优质蛋白比例皆低于城市,脂肪摄入量所占热能比皆达20％以上;碳水化物占热能比约60％左右,比较合理。母乳分泌量城市高于农村。初乳蛋白质含量明显高于其他月龄乳;脂肪含量初乳低于其他各期乳。乳糖含量农村高于城市。婴儿体重前3个月城市与农村无甚区别,4个月以后,农村婴儿生长速度明显低于城市,此可能与农村缺乏婴儿辅助食品和喂养知识有关。     

Nutrient intake in the United States during the first 12 months of life

Nutrient intakes of 463 infants ranging in age from 1 week to 12 months from the Nationwide Food Consumption Survey 1977-78 were evaluated according to different foods (milk and milk products, noniron-fortified formula, iron-fortified formula, infant cereal, commercial baby foods, and table foods). Breast-fed infants and infants fed a combination of cow's milk and formula were excluded. Results indicated that iron was the nutrient most often consumed in amounts less than the RDA. Infants fed a diet that included either cow's milk or noniron-fortified formula had a median iron intake less than the recommended allowance. In comparison, infants who were fed an iron-fortified formula had a median iron intake well above the RDA. The relative proportion of iron derived from different foods is discussed.     

Breast milk zinc and copper concentrations in Bangladesh

Breast-fed infants in Bangladeshi villages were weighed at 1, 2, 6, 9 and 12 months. The concentrations of zinc and copper in the breast milk were measured and the daily intake of these elements calculated. Breast milk Zn concentration decreased over the year but was comparable with that found in developed countries. The calculated daily intake decreased from 17.7 to 8.0 mumol (10-30% of recommended dietary allowances (RDA); National Academy of Sciences, 1980). Breast milk Cu concentration also fell over the year and was lower than that reported from developed countries. Calculated daily Cu intake was 1.95-2.63 mumol (RDA 7.81-15.63 mumol). Deficiencies of trace elements may therefore be a problem in poorly nourished communities where breast feeding is continued for several years with only small amounts of additional food. Breast milk may not be adequate as the only source of infant nutrition after the first few months of life in Bangladesh.     

Food consumption of young stunted and non-stunted children in rural Zambia

OBJECTIVE: The aim of this study was to assess the quality of diet of rural Zambian pre-school children, and to compare the dietary intake of stunted and non-stunted children. DESIGN: Cross-sectional study, in which dietary intake was assessed with a 24-h recall method. Height and weight were measured according to standard procedures. SETTING: Twelve villages in Samfya District, Zambia. SUBJECTS: Children aged 6-9 months ('infants') and 14-20 months ('toddlers'), attending Mother-and-Child Health Clinics, were eligible for study. Excluded were: 12 wasted, and 18 for other reasons. In total 106 infants and 99 toddlers were included. RESULTS: In infants and toddlers, total daily intake of energy, calcium, iron, and vitamin A was insufficient compared to recommended daily intakes. Only infants had insufficient protein intake. Compared to intake from weaning foods, breast milk was the main source of energy and most nutrients for infants. For toddlers, weaning foods were more important. Stunted infants and toddlers tended to have lower intakes of energy compared to non-stunted age-mates. Daily energy intake per kg bodyweight showed no difference between stunted and non-stunted children. CONCLUSIONS: Overall quality of weaning foods was inadequate. Stunted infants and toddlers showed a tendency of lower energy intakes compared to non-stunted age-mates.     

Effects of common illnesses on infants' energy intakes from breast milk and other foods during longitudinal community-based studies in Huascar (Lima), Peru

To assess the effects of common infections on dietary intake, 131 Peruvian infants were observed longitudinally. Home surveillance for illness symptoms was completed thrice weekly, and food and breast-milk consumption was measured during 1615 full-day observations. Mean (+/- SD) energy intakes on symptom-free days were 557 +/- 128 kcal/d (92.4 +/- 26.5 kcal.kg-1.d-1) for infants aged less than 181 d and 638 +/- 193 kcal/d (77.7 +/- 25.7 kcal.kg-1.d-1) for infants aged greater than 180 d. Statistical models controlling for infant age, season of the year, and individual showed significant 5-6% decreases in total energy intake during diarrhea or fever. There were no changes with illness in the frequency of breast-feeding, total suckling time, or amount of breast-milk energy consumed. By contrast, energy intake from non-breast-milk sources decreased by 20-30% during diarrhea and fever, and the small decrements in total energy consumption during illness were explained entirely by reduced consumption of non-breast-milk foods.     

Protein requirements during the first year of life

The composition of human milk provides the model for estimated total protein and essential amino acid requirements during infancy. However, both the total protein content and the concentrations of individual proteins in human milk change throughout the first year of lactation. Recent reassessments of estimated requirements have resulted in lower total protein recommendations and have emphasized the provision of alpha-amino nitrogen because most nonprotein nitrogen is not used for maintenance or tissue deposition. In clinical studies, formulas containing various whey-to-casein ratios and having total protein concentrations in the range of 13-15 g/L were shown to promote adequate growth and to result in biochemical measures of protein nutritional status similar to those in breastfed infants. In the second half of infancy, human milk can provide most of the protein needed, provided a modest protein supply is obtained from weaning foods. In special situations in which greater protein intakes are desired, special preparations of protein might be needed.     

Preliminary data from demographic and health surveys on infant feeding in 20 developing countries

This study describes infant feeding practices in developing countries, specifically complementary liquids and foods in the first year of life. Data were compiled from Demographic and Health Surveys conducted from 1999 to 2003. We analyzed data from those countries with available data, including results for child-level 24-h and 7-d food and fluid intakes. We used datasets from 20 countries with information on >35,000 infants categorized by age: 0-6 and 6-12 mo. For analysis, we grouped data for fluids other than breast milk as water, other milk (e.g., tinned, powdered, animal), infant formula, and other liquids (e.g., fruit juice, herbal tea, sugar water). All specific solid foods were grouped as any solid foods. We present data on breast-feeding and maternal-reported fluid and solid intake by infants in a 24-h period, for individual countries, and in a pooled analysis. Pooled data show that 96.6% of 0- to 6- and 87.9% of 6- to 12-mo-old infants were currently breast-fed. Reported feeding of other fluids was lower among 0- to 6-mo-olds than 6- to 12-mo-olds: water (45.9 vs. 87.4%), other milk products (11.9 vs. 29.6%), infant formula (9.0 vs. 15.1%), and other liquids (15.1 vs. 41.0%). Pooled analysis showed that 21.9% of mothers reported feeding 0- to 6-mo-old infants some type of solid food, and 80.1% of mothers reported feeding solids to 6- to 12-mo-olds. These survey data show that other milks, other liquids, and solid foods are each much more commonly fed throughout infancy than commercial infant formulas in the countries studied.     

Evaluation of test-weighing for the assessment of milk volume intake of formula-fed infants and its application to breast-fed infants

Test-weighing (TW) was evaluated in formula-fed (FF) infants by comparison with direct measurement (DM) of formula intake during a 24 h period at 1, 2, 4 and 6 mo of age. Formula intakes estimated by TW ranged from 87 to 93% of those determined by DM over the 6-mo period. During the study period the number of feedings per day decreased but were not significantly different for FF and BF infants. Volume of intake per feeding by FF infants increased significantly during the 6-mo period whereas milk intakes of BF infants were not different at the four ages studied. These data indicated that when the number of daily feedings decreased with age, FF infants increased their volume of intake per feeding whereas BF infants did not adjust their intakes. Mean volume of milk intake at 4 and 6 mo, estimated by TW, was significantly greater in FF infants compared to breast-fed (BF) infants matched for age and size. Data from this study indicated clearly that when milk intakes of BF infants are compared to those of FF infants, both groups of infants should be test-weighed.     

Effect of diarrhoea on dietary intake by infants and young children in rural villages of Kwara State, Nigeria

Community-based, quantitative studies of dietary intake by 5- to 28-months-old Nigerian children were conducted during episodes of diarrhoea and subsequent convalescent and healthy periods. Energy intakes during diarrhoea (85.3 kcal/kg per d) were slightly lower than during health (95.9 kcal/kg per d, P less than 0.05), using paired analysis of intra-individual differences. When intake was disaggregated by food source, no differences by illness status were found in energy intake from breast milk or liquid pap. There were no differences in frequency or duration of breastfeeding by illness status, but pap was provided more frequently and in smaller amounts during illness. Energy intake from other foods, including solids, was greater during health than diarrhoea (P less than 0.05) with an increase in number of servings per day. There was no evidence of caretakers either withholding food during illness or providing extra food during the convalescent phase. The magnitude of illness-associated differences in these children's daily intake was small relative to the deficit in their intakes, even on healthy days, when compared to the amounts recommended for this age group.     

Nutritional transition during infancy in East Java, Indonesia: 2. A longitudinal study of growth in relation to the intake of breast milk and additional foods

Weight and length of infants, born in two villages in Madura, East Java were measured longitudinally from birth to 12 months (n = 391). In a sub-sample (n = 76) the intake of breast milk and additional foods during 48 h were also measured. The shape of the weight curve of Madurese infants is comparable to that of healthy, exclusively breast-fed infants in the UK and US during the first 6 months of life, in spite of the custom to force-feed from as early as the first week. The use of a more 'appropriate' growth curve of exclusively breast-fed, healthy infants instead of the NCHS reference failed to define more accurately the age at which growth faltering starts. It is recommended to use weight increments as an indicator of the onset of growth faltering. Breast milk intake correlated significantly with attained weight. However, it explains only a small percentage of the variation in weight, viz. 12-24 per cent. There was no correlation between energy or protein intake from breast milk and additional foods and weight gain.     

Foods, nutrients and portions consumed by a sample of Australian children aged 16–24 months

Aim:  To describe the diet of a sample of Australian children aged 16–24 months with regard to the amounts of foods and nutrients consumed.
Methods:  Cross-sectional data collected from participants in a five-year randomised trial of the primary prevention of asthma. Pregnant women with a family history of atopy were recruited from six hospital antenatal clinics in western Sydney. At the 18-month assessment, carers of 429 of children completed three-day weighed food records. Three-day average intakes of foods and nutrients and average portions per eating occasion for commonly consumed foods. T -tests for comparing gender differences.
Results:  Diets were characterised by large amounts of milk and non-milk drinks with smaller amounts of cereals, fruits, vegetables and meats. Total energy intake was significantly higher for boys than girls and exceeded estimated energy requirements in both boys and girls. Food groups contributing most to energy included milk and milk products (35%), cereals (15%), cereal-based products (9%) and non-milk drinks (8%). Micronutrient intakes were below the Estimated Average Requirement in more than 5% of the children for vitamin A, calcium, vitamin C and iron. Sodium intakes exceeded the upper level of 1000 mg for 62% of children, while dietary fibre intake was only half the Adequate Intake of 14 g. Relatively few foods were widely consumed and median portion sizes were typically small in relation to commonly used reference portion sizes.
Conclusion:  These data may be useful as a preliminary basis for developing age-specific dietary surveillance tools and dietary guidance for children aged one to two years.     

Delayed onset of weanling diarrhoea associated with high breast milk intake

In a West African community where breast feeding was practised universally for 18 to 24 months infants with the higher breast milk intakes were given supplementary foods later than others. Although 66% of infants had diarrhoea before the introduction of these foods, it was generally mild and only 12% suffered diarrhoea-induced weight loss in this pre-weaning period. By the end of infancy, all children had had diarrhoea and 89% had suffered weight loss in one or more attacks. As the bulk of diarrhoeal morbidity occurred after weaning had started, children with the higher breast milk intakes tended to be older before losing weight with diarrhoea. By one year, children with a higher than average breast milk intake and with no diarrhoea-induced weight loss in the first half of infancy weighed an average of 1 kg more than those with low breast milk intakes and early weight loss with diarrhoea. Interventions which improve or maintain maternal lactation performance should not only increase the nutrient intake of an infant, but also delay the almost inevitable weight loss of weanling diarrhoea.     

Lactating women restricting milk are low on select nutrients

OBJECTIVE: Currently there are no recommendations for vitamin/mineral supplementation for lactating women but supplementation may be important, particularly for those women who choose to restrict milk intake during lactation. The objective of this study was to assess nutrient adequacy for lactating women and compare their dietary intake, including supplements, between those who restrict milk and those who do not. METHODS: A cohort of 175 healthy exclusively breast-feeding women (19-45 yrs) recruited from prenatal classes were divided into milk restrictors (RS) defined as milk intake < or = 250 ml/day and non-restrictors (NRS) (>250 ml/day) and followed for six months postpartum. Participants provided repeated 24-hr dietary recalls, detailed use of vitamin/mineral supplements and reasons for restricting milk. Statistical Analyses: Observed intakes were adjusted to remove day-to-day variability. Nutrient intakes were estimated for macronutrients and vitamins C, D, thiamin, riboflavin, niacin, and minerals, calcium and zinc, with and without vitamin/mineral supplements. Chi-square was used to compare the number of RS and NRS with intakes less than the Estimated Average Requirement (EAR). RESULTS: Milk restriction was practiced by 23% of the sample. Sixty per cent of RS reported protein intakes 相似文献   

Dietary and Complementary Feeding Practices of US Infants, 6 to 12 Months: A Narrative Review of the Federal Nutrition Monitoring Data

Complementary foods and beverages (CFBs) are key components of an infant’s diet in the second 6 months of life. This article summarizes nutrition and feeding practices examined by the 2020 Dietary Guidelines Advisory Committees during the CFB life stage. Breastfeeding initiation is high (84%), but exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). Most infants (51%) are introduced to CFBs sometime before 6 months. The primary mode of feeding (ie, human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFBs is associated with the timing of introduction and types of CFBs reported. FMF infants (42%) are more likely to be introduced to CFBs before 4 months compared with HMF infants (19%). Different dietary patterns, such as higher prevalence of consumption and mean amounts, were observed, including fruit, grains, dairy, proteins, and solid fats. Compared with HMF infants of the same age, FMF infants consume more total energy (845 vs 631 kcal) and protein (22 vs 12 g) from all sources, and more energy (345 vs 204 kcal) and protein (11 vs 6 g) from CFBs alone. HMF infants have a higher prevalence of risk of inadequate intakes of iron (77% vs 7%), zinc (54% vs <3%), and protein (27% vs <3%). FMF infants are more likely to have an early introduction (<12 months) to fruit juice (45% vs 20%) and cow’s milk (36% vs 24%). Registered dietitian nutritionists and nutritional professionals should consider tailoring their advice to caregivers on dietary and complementary feeding practices, taking into account the primary mode of milk feeding during this life stage to support infants’ nutrient adequacy. National studies that address the limitations of this analysis, including small sample sizes and imputed breast milk volume, could refine findings from this analysis.     

Effects of early extra fluid and food intake on breast milk consumption and infant nutritional status at 5 months of age in an urban and a rural area of Burkina Faso

OBJECTIVE: To assess the effects of early extra fluid and food intake on breast milk consumption and the effects of food intake on 5-month-old infant nutritional status. DESIGN: Cross-sectional surveys. Infants were selected by random choice. SETTINGS: Urban and rural Burkina Faso. SUBJECTS: A total of 97 urban and 69 rural infants were recruited, but 67 and 51, respectively, completed the surveys. Infant selection criteria were: age (5 +/- 0.5-month old), thriving, breastfed, having Burkinabè parents in study area for a year, study conditions accepted by parents. INTERVENTION: Surveys were conducted respectively in January and February 2001 (urban), and 2002 (rural) during the cool season. They were performed by home visit. With the help of health workers and traditional midwives, families were informed of the studies' objectives and gave agreement. Food intakes were estimated by test-weighing for breast milk and precise weighing techniques for other foods. Socioeconomic status of households, anthropometry of infants and mothers were also recorded. Breast milk samples were collected from each mother's breast and analysed for lipid and fatty acid concentrations. RESULTS: Daily breast milk intake did not differ between urban (776 +/- 262 g) and rural areas (835 +/- 265 g). Porridge intake was, respectively, 128 +/- 105 and 96 +/- 49 g. Median extra fluid intake was, respectively, 79 and 122 g. In both areas, porridge and fluid intake had no effect on breast milk consumption. In urban areas, infant nutritional status at 5 months was better than at birth. CONCLUSION: Breast milk intake and nutritional status of predominantly breastfed infants at 5 months of age, living in both urban and rural settings, were not affected by the consumption of extra fluid or food intake.     

Nutrient intakes of older infants: effect of different milk feedings

Using 24-hour dietary and nutrient intake of 293 infants 7-12 months of age from NHANES II, 1976-80, we determined the hypothetical effects of different milk feedings on total intake of 12 nutrients. Infants were grouped by age at 7-8, 9-10, and 11-12 months. Human milk (HM), Fe-fortified infant formula (I-FM), whole cow's milk (WCM), and 2% lowfat milk (2%) were substituted to provide the same energy as that calculated from the difference between median energy intake provided by solid foods and the total diet. Nutrients from milk feedings were added to median nutrient intake from solid foods. Use of WCM or 2% resulted in low total intakes of Fe (6.3-11.1 mg) and linoleic acid (0.5-2.5 g) and high intakes of protein (32-47 g), Na (630-1,200 mg), K (1,400-1,900 mg), and Ca (920-1,170 mg) relative to the RDA. Feeding of HM provided total intakes that met the RDA for each nutrient except Fe (6.1-10.8 mg) and Ca (350-370 mg). When I-FM was fed, the RDA was met for each nutrient except Ca (370-490 mg) at all ages and Fe (13.1 mg) at 11-12 months. Estimated safe and adequate daily intake of Na was exceeded at 9-10 months by infants fed WCM/2% and at 11-12 months by all infants regardless of milk feeding, primarily because of the high Na content of solid foods. These data confirm that the milk feeding is still the major determinant of total nutrient intake in the second 6 months of life.     

Effects of the duration of the habituation period on energy intakes from low and high energy density gruels by Burkinabè infants living in free conditions

The present study was carried out in Ouagadougou (Burkina Faso) with the aim of determining if the duration of the habituation period (1, 5 or 10 days) to low and high energy density gruels affected the amounts consumed or the energy intakes from gruels consumed by 6-9-month-old infants. Thirty infants were chosen randomly among the eligible children in the study area and randomly assigned to two groups (S1 and S2). Each infant was given successively for 10 consecutive days two experimental gruels, each type of gruel being fed twice a day. The 15 infants in group S1 received low energy density gruel (G1) in the first period and high energy density gruel (G2) in the second, and the 15 infants in group S2 received G2 in the first period and G1 in the second. The two periods of 10 days were separated by 4 days during which the infant received his or her usual foods. The intakes of experimental gruels and other complementary foods were measured on days 1, 5 and 10 of each period. Whatever the type of gruel, the 10-day period of habituation did not result in an increase in the amounts consumed or in the energy intakes from these gruels. The amounts of G1 consumed on day 5 were significantly higher than those of G2 (9.0 vs 6.8 g/kg/meal; p = 0.044). Energy intakes from G2 were significantly higher than those from G1 on days 1 (28.8 vs 18.0 kJ/kg/meal; p = 0.0002), 5 (28.8 vs 19.2 kJ/kg/meal; p = 0.002) and 10 (25.9 vs 15.5 kJ/kg/meal; p = 0.0004). Daily frequencies of breastfeeding (approximately 5.6), water drinking (approximately 3.7) and meals with foods other than experimental gruels were relatively high and did not vary with the duration of the habituation period or the type of gruels. Whatever the type of gruel, the increase in the duration of the habituation period did not increase the amount consumed or energy intakes. The study confirmed that consumption of high energy density gruels led to a 60% increase in energy intakes in comparison with the consumption of low energy density gruels.