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.     

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 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.     

Calcium intake: covariates and confounders.

One common nutrient postulated to be protective against osteoporosis, hypertension, and colon cancer is dietary calcium. We report here nutrient patterns by calcium intake in older adult residents of a geographically defined community in Southern California. The analysis included all 426 men and 531 women aged 50-79 y with complete 24-h diet data. Nutrient-density-adjusted calcium intake was divided into tertiles: low intake (less than 284 mg/1000 kcal), mid intake (284-440 mg/1000 kcal), and high intake (greater than 440 mg/1000 kcal). The distribution of the reported 24-h nutrient density of protein, fat, fiber, caffeine, trace minerals, vitamin D, and vitamin C was examined in relation to the calcium-intake tertiles. In both men and women, the adjusted intakes of protein, saturated fatty acids, vitamin D, magnesium, and phosphorus were significantly higher in the high-calcium-intake group than in the low- and mid-calcium-intake groups. In both men and women, alcohol intake was significantly lower in the high-calcium-intake group. Studies postulating a protective role for calcium will need to consider the multicolinearity in the Western diet.     

Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking.

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.     

Evaluation of Nutrient Intake and Food Consumption among Dutch Toddlers

Improving dietary habits at a young age could prevent adverse health outcomes. The aim was to gain insight into the adequacy of the dietary intake of Dutch toddlers, which may provide valuable information for preventive measures. Data obtained from the Dutch National Food Consumption Survey 2012–2016 were used, which included 672 children aged one to three years. Habitual intakes of nutrients were evaluated according to recommendations set by the Dutch Health Council. Specific food groups were evaluated according to the Dutch food-based dietary guidelines. For most nutrients, intakes were estimated to be adequate. High intakes were found for saturated fatty acids, retinol, iodine, copper, zinc, and sodium. No statement could be provided on the adequacy of intakes of alpha-linoleic acids, N-3 fish fatty acids, fiber, and iron. 74% of the toddlers used dietary supplements, and 59% used vitamin D supplements specifically. Total median intakes of vegetables, bread, and milk products were sufficient. Consumption of bread, potatoes and cereals, milk products, fats, and drinks consisted largely of unhealthy products. Consumption of unfavorable products may have been the cause of the observed high and low intakes of several nutrients. Shifting towards a healthier diet that is more in line with the guidelines may positively affect the dietary intake of Dutch toddlers and prevent negative health impacts, also later in life.     

Predictors of nutritional adequacy in mother-toddler dyads from rural families with limited incomes

OBJECTIVE: To predict the mean adequacy ratio (MAR) scores of mothers and toddlers from intakes of fruits, vegetables, and dairy group foods and being seated during mealtimes. DESIGN/SUBJECTS: This was a regression analysis of cross-sectional data of the diet quality and being seated during mealtimes of 100 rural mother-toddler dyads from limited-income families using two 24-hour dietary recalls. Children were 11 to 25 months of age and at or below 100% of the poverty index. MEASURES OF OUTCOME: Dietary quality for mothers and toddlers was assessed using a MAR score for eight different nutrients (vitamin A, vitamin C, vitamin D, folate, calcium, zinc, iron, and magnesium), and a score of 85 or above was considered nutritionally adequate. The main food groups of interest were servings from the fruits, vegetables, and dairy group foods. Mealtime sitting behavior was the percentage of times the toddler remained seated while eating. RESULTS: Servings of fruits, vegetables, and dairy foods predicted 0.62 of the variance in the mother's MAR score, whereas vegetable and dairy intakes along with being seated while eating indicated nutritional adequacy for toddlers. Mothers with low MAR scores were most likely to have toddlers with poor diets, although few toddlers had poor diet quality. CONCLUSIONS: Adequate intakes of dairy, vegetables, and whole fruits along with being seated while eating could be quick assessment tools to screen toddlers for nutritional risk. Mothers with poor diet quality were likely to have toddlers with poor diets; low intakes of fruits, vegetables, and dairy foods were markers for poor diet quality in mothers.     

Diet quality in young children is influenced by beverage consumption

BACKGROUND: Replacement of milk with sugar-containing beverages could affect calcium intake and overall diet quality. OBJECTIVE: To describe dairy food, 100% juice and added sugar beverage intakes, contributions of dairy foods to diet quality, and effects of beverages on diet quality in young children. METHODS: We surveyed participants in the Iowa Fluoride Study (n = 645) at ages 1, 2, 3, 4 and 5 years and calculated intakes for 1-5 years (i.e. weighted averages). Nutrient, dairy food and beverage intakes were obtained from 3-day diaries; nutrient adequacy ratios were calculated as the nutrient intake to Recommended Dietary Allowance/Adequate Intake ratio; and dairy-dependent percentages were calculated as fractions of total diet nutrient adequacy ratios (truncated at 1) not met by non-dairy foods. RESULTS: Milk intakes were inversely associated with intakes of juice drinks (2, 4, 5 and 1-5 years), soda pop (2, 3, 4, 5 and 1-5 years) and added sugar beverages (2, 3, 4, 5 and 1-5 years). Dairy dependent fractions of 1-5 year nutrient adequacy ratios were 68% for calcium and 61% for vitamin D. Higher 1-5 year calcium adequacy was predicted by higher energy, higher other dairy and lower added sugar beverage intakes while higher vitamin D adequacy was predicted by higher energy and higher other dairy intakes. Overall diet quality was predicted by higher energy, higher other dairy, lower 100% juice and lower added sugar beverage intakes. CONCLUSIONS: Dairy foods remain an important source of calcium and vitamin D, while added sugar beverages and, to a lesser extent, 100% juice decrease diet quality of young children.     

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.     

Prevalence of nutritional inadequacy in children aged 12–36 months: EPACI Portugal 2012

Adequate nutritional intake in the first years of life is crucial for future health. The purpose of this study is to assess the adequacy of nutritional intake in Portuguese toddlers. The EPACI Portugal 2012 is a cross-sectional study of a representative sample of toddlers (n = 2230), aged between 12 and 36 months. Data on diets were collected by trained interviewers. The current analysis included 853 children with full data from 3-day food diaries completed by parents/caregivers. Intakes of energy, macro- and micronutrients were estimated through Statistical Program to Assess Dietary Exposure (SPADE). Nutritional adequacy was evaluated using Dietary Reference Values established by the European Food Safety Authority. A large proportion of children exceeded the recommended energy intake. The median daily protein intake was 4.7 g/kg/day, five times more than that recommended. About 9% and 90% of the children consumed a lower proportion of energy than the lower limit of the Reference Intake range for carbohydrates and fat, respectively. Around a third consumed less fibre and magnesium and 100% less vitamin D than the recommended Adequate Intake (AI). Almost a third consumed less vitamin A than the recommended Average Requirement (AR) and 86% of the children showed excessive sodium consumption. Portuguese toddlers consumed a low proportion of energy from fat, had energy and protein intakes above the recommendations and excessive intakes of sodium, and inadequate intakes of vitamin A. Every child consumed less than the recommended AI for vitamin D.     

A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada

Although supplement use is prevalent in North America, there is little information on how supplements affect the prevalence of nutrient adequacy or risk of intakes greater than the tolerable upper intake level (UL). The objectives of this study were to compare the prevalence of nutrient adequacy and percent of intakes greater than the UL from diet alone between supplement users and nonusers and determine the contribution of supplements to nutrient intakes. Dietary intakes (24-h recall) and supplement use (previous 30 d) from respondents ≥1 y in the Canadian Community Health Survey 2.2 (n = 34,381) were used to estimate the prevalence of nutrient adequacy and intakes greater than the UL. Software for Intake Distribution Evaluation was used to estimate usual intakes. The prevalence of nutrient adequacy from diet alone was not significantly higher among supplement users than nonusers for any nutrient. Based on diet alone, children 1-13 y had a low prevalence of nutrient adequacy (<30%) except for vitamin D and calcium. Among respondents ≥14 y, inadequacies of vitamins A and D, calcium, and magnesium were >30%. For other nutrients, there was a low prevalence of nutrient adequacy. There were no nutrient intakes greater than the UL from diet alone, except zinc in children. When supplements were included, ≥10% of users in some age/sex groups had intakes of vitamins A and C, niacin, folic acid, iron, zinc, and magnesium greater than the UL, reaching >80% for vitamin A and niacin in children. In conclusion, from diet alone, the prevalence of nutrient adequacy was low for most nutrients except for calcium, magnesium, and vitamins A and D. For most nutrients, supplement users were not at greater risk of inadequacy than nonusers; supplement use sometimes led to intakes greater than the UL.     

Diet intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets

A multicentered pilot study was conducted to test an intervention protocol designed to reduce fat intake to 15% of energy intake. Eligible subjects were postmenopausal women with stage II breast cancer whose baseline fat intake was more than 30% of energy intake. The low-fat diet intervention protocol consisted of bi-weekly individual counseling sessions with emphasis on substitution of lower-fat foods for high-fat foods and maintenance of nutritional adequacy. Nutrient intakes were calculated from 4-day food records collected at baseline and after 3 months of diet intervention. Mean daily fat intake for the 17 patients on the low-fat diet dropped significantly from 38.4 +/- 4.3% of energy intake at baseline to 22.8 +/- 7.8% at 3 months (p less than .001). A 25% reduction in mean energy intake, from 1,840 +/- 419 kcal at baseline to 1,365 +/- 291 kcal at 3 months, was accompanied by significant increases in protein and carbohydrate as percent of energy intake. A mean weight loss of 2.8 kg and a 7.7% reduction in serum cholesterol were observed; both changes were significant at the p less than .01 level. Absolute intakes of zinc and magnesium were significantly reduced. However, mean intake on the low-fat diet for 14 vitamins and minerals, including zinc and magnesium, exceeded two-thirds of the 1989 Recommended Dietary Allowances (RDAs). When expressed as nutrient density (i.e., amount of nutrient per 1,000 kcal), increases were observed for all micronutrients. These results support the hypothesis that a nutritionally adequate low-fat diet can be successfully implemented in a highly motivated, free-living population.     

Designing snacks to address micronutrient deficiencies in rural Kenyan schoolchildren

Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy.     

Diet and disadvantage: observations on infant feeding from an inner city

Background: There are few detailed nutritional studies analysing dietary intakes and weaning practices of inner city infants aged 0–12 months. Pasteurized cow's milk (PCM) is not recommended as a main drink until after 1 year of age, although early usage is still common. Premature introduction of pasteurized cow's milk is associated with increased risk of iron deficiency anaemia. Methods: We therefore prospectively examined the dietary effect of early introduction of pasteurized cow's milk on the nutritional intake of 100 infants (mean age at recruitment 7.8 months), whose mothers had already elected to introduce cow's milk before the recommended age of 12 months in a deprived inner city area. In addition, a retrospective questionnaire on feeding practices and food choices was administered and information on parental education and employment was collected, together with a 3-day dietary diary of weighed intakes at recruitment. Results: The results indicate that weaning practices are handed down from family and friends and are intuitive rather than informed. Over 80% of the infants had intakes of iron, zinc and vitamin D below the reference nutrient intake (RNI) and a further 41% had low vitamin C intakes. Prior to introduction of PCM, there was also misuse of infant formula. Twenty per cent added an extra scoop of powder to the feeds, 10% added milk powder to the bottle before addition of water and 30% used microwave ovens to heat the infant bottle. Conclusion: Feeding practices in a deprived inner city area differed substantially from guidelines and infants were at risk of developing nutrient deficiencies as well as poor feeding practices.     

Nutrient intakes of toddlers and preschoolers in Greece: the GENESIS study

There are only a few studies assessing the nutrient intake of Greek children in the literature. Therefore, the aim of this study was to assess the nutrient adequacy of the diets of a representative sample of 2,374 toddlers and preschoolers with full anthropometric and dietary intake data. Usual nutrient intakes were calculated after adjusting raw data for within-person variance and correcting for underreporting. The percentages of children meeting or not meeting recommendations for energy and nutrient intakes were estimated. Differences in mean values were tested with one-way analysis of variance, while chi(2) and Fisher exact tests were used to explore the association between categorical variables. For both fat and carbohydrate, a substantial percentage of toddlers and preschoolers had usual intakes outside the acceptable macronutrient distribution range, whereas protein was less than this range. "At risk of overweight" and "overweight" children consumed more total energy, protein, and fat compared with their normal-weight counterparts, whereas no differences were found for micronutrient intakes. The estimated prevalence of inadequacy was found to be between 10% and 25% for niacin, vitamin E, and folate. Usual intakes exceeding the Tolerable Upper Intake Levels were recorded for zinc and copper.     

Assessment of Nutrient Adequacy with Supplement Use in a Sample of Healthy College Students

Objectives: Limited information is available on the nutritional status and the impact of supplements on nutrient adequacy in college students. This study aimed to assess nutritional status and evaluate the contribution of supplement use to overall nutrient adequacy in a sample of healthy college students.

Methods: Sixty subjects (40 women and 20 men) were randomly recruited from those attending the University of Connecticut. Food records were collected over 30 consecutive days for each subject. In addition, health and lifestyle information was collected at the beginning and end of the study period.

Results: After excluding misreporting, only 44 subjects were eligible for assessing nutritional status. More than 40% of female students had intakes below the estimated average requirements for vitamins D and E, calcium, and magnesium. Supplement users had significantly higher average intakes than nonusers from dietary sources for protein, folate, niacin, vitamin E, magnesium, and zinc (p < 0.05). With the addition of supplements, supplement users consumed significantly more for all nutrient intakes except vitamin A than nonusers (p < 0.05). Nutritional adequacy of supplement users was significantly higher for vitamins D and E and magnesium compared with nonusers (p < 0.05).

Conclusions: Overall, men and women were consuming intakes below adequacy for most nutrients, and supplement usage increased nutrient intake and adequacy levels in this young adult population.     

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

(1) Background: Breastmilk provides all the nutrition an infant requires between 0–6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6– 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 75% and 20%, respectively, for infants aged 6–11.9 months. Low iron intake was also observed in one quarter of toddlers 12–24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6–11.9 months and toddlers 12–24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.     

Effects of a low-fat vegan diet and a Step II diet on macro- and micronutrient intakes in overweight postmenopausal women

OBJECTIVE: This study investigated the nutrient intake of overweight postmenopausal women assigned to a low-fat vegan diet or a Step II diet. METHODS: Fifty-nine overweight (body mass index, 26 to 44 kg/m2) postmenopausal women were randomly assigned to a self-selected low-fat vegan or a National Cholesterol Education Program Step II diet in a 14-wk controlled trial on weight loss and metabolism. Nutrient intake, which was measured per 1000 kcal, was the main outcome measure. Statistical analyses included within-group and between-group t tests examining changes associated with each diet. RESULTS: Consumption of a low-fat vegan diet was associated with greater decreases in fat, saturated fat, protein, and cholesterol intakes and greater increases in carbohydrate, fiber, beta-carotene, and total vitamin A intakes than was a Step II diet. The low-fat vegan group also increased thiamin, vitamin B6, and magnesium intakes more than the Step II group, and both groups increased folic acid, vitamin C, and potassium intakes. If considering only food sources of micronutrients, the low-fat vegan group decreased vitamin D, vitamin B12, calcium, selenium, phosphorous, and zinc intakes compared with baseline. However, with incidental supplements included, decreases were evident only in phosphorous and selenium intakes. No micronutrient decreases were found in the Step II group. CONCLUSIONS: Individuals on a low-fat vegan or Step II diet should take steps to meet the recommended intakes of vitamin D, vitamin K, folic acid, calcium, magnesium, and zinc. Individuals on a low-fat vegan diet should also ensure adequate intakes of vitamin B12, phosphorous, and selenium.     

Do vitamin and mineral supplements improve the dietary intake of elderly Canadians?

The prevalence of nutritional supplementation and the relationship of the adequacy of the diet to the use of nutritional supplements was investigated in a group of 82 healthy, free-living elderly Canadians. Dietary data included a seven-day food record and the reported daily intake of vitamin or mineral supplements. 43% of the men and 62% of the women reported using vitamin and/or mineral supplements during the preceding year. Current use (at the time of interview) was reported in 35% of the study subjects. Supplement users did not differ from non-users in terms of dietary intake from diet alone for any of the nutrients compared. Few subjects corrected inadequate intakes by the use of nutrient supplements; in fact, most supplements were consumed by those not at risk of deficiency for the particular vitamin or mineral. Reliance upon vitamin and/or mineral supplementation for adequate nutrient intake without a dietary evaluation is not recommended.     

Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children

BACKGROUND: Information is needed on the minimum energy density and feeding frequency of complementary foods that can provide adequate energy intakes (EIs) for healthy breastfed children. OBJECTIVES: The objectives of the study were to evaluate the effects of various energy densities and feeding frequencies of complementary foods on EI from these foods, breast milk consumption, and total EI from both sources. DESIGN: During 9 separate, randomly ordered dietary periods lasting 3-6 d each, we measured intakes of food and breast milk by 18 healthy breastfed children 8-11 mo of age who, 3, 4, or 5 times/d, were fed porridge with a coded energy density of 0.5, 1.0, or 1.5 kcal/g. Food intake was measured by weighing the feeding bowl before and after meals, and breast milk intake was measured by test weighing. RESULTS: The mean amounts of complementary foods consumed were inversely related to their energy density and positively related to the number of meals/d (P < 0.001 for both); EIs from foods were positively related to both factors. Breast milk intake decreased slightly but progressively, with greater energy density and feeding frequency of complementary foods; total EIs (kcal/d) increased in relation to both factors (P < 0.001 for both). CONCLUSIONS: The energy density and feeding frequency of complementary foods affect infants' total daily EI and breast milk consumption. Recommendations can be developed for the appropriate combinations of these dietary factors that are compatible with adequate EI, although longer-term effects of complementary feeding practices on breast milk intake and breastfeeding duration need further community-based studies.