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Correct Complementary Feeding Practice as a Nutritional Tool for NCDs’ Prevention

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Policies and Education for Health Promotion".

Deadline for manuscript submissions: closed (15 April 2022) | Viewed by 68510

Special Issue Editors

Independent Researcher, 00162 Rome, Italy
Interests: pediatric nutrition; children and families' nutritional education; breastfeeding; weaning; pediatric micronutrient deficiencies; childhood obesity; malnutrition; obesity-related pathologies; adolescent medicine; nutritional issues in adolescence; nutritional issues in eating disorders
Previously at Nutrition Unit at Prevention Department of Azienda Sanitaria Locale, Brindisi, Italy
Interests: paediatric nutrition; development of eating habits; childhood obesity; nutritional education; preventive interventions; weaning; food marketing

Special Issue Information

Dear Colleagues,

The first 1000 days of life are presently seen as, possibly, the most important period of our whole existence, during which correct nutritional practices are able to influence the future of the human being, mainly through epigenetic modifications. While the importance and role(s) of exclusive breastfeeding are quite well established, and yet still under study, the influence of the period of time immediately following breastfeeding, and approximately covering the span 6 months–2 years of age, i.e., the weaning period, is much less clear. Many reasons for this uncertainty can be identified, and they have been quite well examined in the past by Adair (Nutrition, Metabolism and Cardiovascular Diseases, 2012) . Nonetheless, in the last decade many other studies have been performed, and we are now able to tell more about the topic. Even though differences in local culture and family traditions play an important role in modeling weaning practices, making it still difficult to lead the weaning process back to its fundamental roots, some universal aspects (such as the timing of a correct weaning start, and nutritional compositions of meals) seem to be now clearer than they were in the past. 

This Special Issue will collate recent high-quality research in the field of breastfeeding, weaning, and NCDs' prevention. Both original research articles and reviews work are welcome. 

Prof. Dr. Andrea Vania
Dr. Margherita Caroli
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breastfeeding
  • weaning practices
  • non-communicable diseases (NCDs)
  • timing
  • macronutrients intake
  • micronutrients
  • responsive complementary feeding
  • Baby-Led Weaning (BLW)
  • BLISS
  • baby food marketing
  • obesity
  • hypertension
  • cardio-vascular diseases (CVDs)
  • microbiota
  • epigenetics
  • eating habits development

Published Papers (17 papers)

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Research

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19 pages, 344 KiB  
Article
Nutritional Assessment of Baby Food Available in Italy
Nutrients 2022, 14(18), 3722; https://doi.org/10.3390/nu14183722 - 09 Sep 2022
Cited by 3 | Viewed by 1493
Abstract
Adequate complementary feeding practices are important for short- and long-term child health. In industrialized countries, the formulation of several commercial baby foods (CBFs) and an increase in their consumption has been noticed. Aim: To update and analyze the nutritional composition of CBFs available [...] Read more.
Adequate complementary feeding practices are important for short- and long-term child health. In industrialized countries, the formulation of several commercial baby foods (CBFs) and an increase in their consumption has been noticed. Aim: To update and analyze the nutritional composition of CBFs available in the Italian market. Methods: Data collection carried out in two steps (July 2018–January 2019) and updated in May–September 2021. The information on CBFs was taken from the websites of the major CBF producers available in Italy. The collected information were: Suggested initial and final age of consumption; Ingredients; Energy value; Macronutrients (protein, lipids, and carbohydrates); Fiber; Micronutrients (sodium, iron, and calcium); Presence of salt and added sugars, flavorings, and other additives. Results: Time-space for which CBFs are recommended starts too early and ends too late; protein content is adequate and even too high in some food; Amount of fats and their quality must be improved, keeping the intake of saturated fats low; Sugar content is too high in too many CBFs and salt is unnecessarily present in some of them. Finally, the texture of too many products is purée, and its use is recommended for too long, hindering the development of infants’ chewing abilities. Full article
16 pages, 900 KiB  
Article
Infant Feeding Practices That Substitute Exclusive Breastfeeding in a Semi-Rural Mexican Community: Types, Moments, and Associated Factors
Nutrients 2022, 14(10), 2017; https://doi.org/10.3390/nu14102017 - 11 May 2022
Cited by 2 | Viewed by 1942
Abstract
International organizations recommend mothers practice exclusive breastfeeding (EBF) during the first six months of their infant’s life and introduce complementary feeding (CF) thereafter while continuing breastfeeding. However, the earlier introduction of liquids and foods is common worldwide and may have negative effects on [...] Read more.
International organizations recommend mothers practice exclusive breastfeeding (EBF) during the first six months of their infant’s life and introduce complementary feeding (CF) thereafter while continuing breastfeeding. However, the earlier introduction of liquids and foods is common worldwide and may have negative effects on breastfeeding practice, nutrition, and health. In this formative cross-sectional study, we interviewed 143 mothers from semi-rural communities in Tabasco, Mexico, whose infants were 4–6 months old. We explored (1) which feeding practices substituted EBF and (2) which factors were associated with each practice. During the first month of life, 42.7% of infants received formula milk (FM); this proportion increased to 74.5% by the sixth month. Adjusted Poisson regression analyses showed that giving FM was positively related to working away from home (PR 1.27; 95% CI 1.06, 1.54) and the perception that FM is an important food to accompany breast milk (PR 1.38; 95% CI 1.19, 1.70). Giving FM was negatively associated with not being sure the infant is full after breastfeeding (PR 0.75; 95% CI 0.61, 0.92). Regarding CF, less than half (47.5%) of infants had not received it by the fifth month. Factors positively associated with timely CF introduction were: the mother was told during prenatal care visits the optimal age to start CF is 6 months (PR 1.17, 95% CI 1.06, 1.29); she is convinced that giving only breast milk is best for her baby (PR 1.15, 95% CI 1.03, 1.29), and a higher infant weight-for-length (PR 1.04, 95% CI 1.00, 1.08) and length for age (PR 1.04, 95% CI 1.00, 1.09) z-scores at the study visit; conversely, it was negatively associated to the idea that if the infant is not full, she/he should receive formula milk or some other food (PR 0.87, 95% CI 0.78, 0.96). In these communities, EBF is lost to the use of FM and early CF. The factors associated with these inadequate feeding practices are related to returning to work, information received during prenatal visits, and the mother’s beliefs and thoughts. This work will guide the design of an intervention on infant feeding practices for these communities and other similar ones. Full article
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16 pages, 1294 KiB  
Article
Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial
Nutrients 2021, 13(11), 3946; https://doi.org/10.3390/nu13113946 - 04 Nov 2021
Cited by 5 | Viewed by 2790
Abstract
This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused [...] Read more.
This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers’ weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of “What We Eat in America” food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity. Full article
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14 pages, 299 KiB  
Article
Breastfed and Formula-Fed Infants: Need of a Different Complementary Feeding Model?
Nutrients 2021, 13(11), 3756; https://doi.org/10.3390/nu13113756 - 24 Oct 2021
Cited by 5 | Viewed by 3073
Abstract
Suboptimal nutrient quality/quantity during complementary feeding (CF) can impact negatively on infants’ healthy growth, even with adequate energy intake. CF must supplement at best human milk (HM) or formulas, which show nutritional differences. Considering this, a differentiated CF is probably advisable to correctly [...] Read more.
Suboptimal nutrient quality/quantity during complementary feeding (CF) can impact negatively on infants’ healthy growth, even with adequate energy intake. CF must supplement at best human milk (HM) or formulas, which show nutritional differences. Considering this, a differentiated CF is probably advisable to correctly satisfy the different nutritional needs. To assess whether current needs at 6–24 months of age can still be met by one single CF scheme or different schemes are needed for breastfed vs. formula/cow’s milk (CM) fed infants, protein, iron and calcium intakes were assessed from daily menus using the same type and amount of solid food, leaving same amounts of HM and follow-up formula at 9 and again 18 months of age, when unmodified CM was added. Depending on the child’s age, calcium- and iron-fortified cereals or common retail foods were used. The single feeding scheme keeps protein intake low but higher than recommended, in HM-fed children while in formula/CM-fed ones, it achieves much higher protein intakes. Iron Population Recommended Intake (PRI) and calcium Adequate Intakes (AI) are met at the two ages only when a formula is used; otherwise, calcium-fortified cereals are needed. ESPGHAN statements on the futility of proposing different CF schemes according to the milk type fed do not allow to fully meet the nutritional recommendations issued by major Agencies/Organizations/Societies for all children of these age groups. Full article
8 pages, 235 KiB  
Article
Exploring Physicians’ Perspectives on the Introduction of Complementary Foods to Infants and Toddlers
Nutrients 2021, 13(10), 3559; https://doi.org/10.3390/nu13103559 - 12 Oct 2021
Cited by 1 | Viewed by 1927
Abstract
Complementary feeding is the subject of many recommendations regarding the benefits of its use, illustrating its crucial impact on further health. However, it still poses a significant problem for caregivers, and thus for doctors. This survey focused on nutritional problems faced by the [...] Read more.
Complementary feeding is the subject of many recommendations regarding the benefits of its use, illustrating its crucial impact on further health. However, it still poses a significant problem for caregivers, and thus for doctors. This survey focused on nutritional problems faced by the parents of infants and toddlers, as well as how physicians deal with these problems. Based on the responses from 303 doctors, it was determined that the time and sequence of introducing complementary foods raise the greatest doubts in parents. This study also found that at least one-third of pediatricians experience difficulties in providing effective nutritional counseling. Increasing the nutritional awareness of physicians can allow them to provide more appropriate support to parents. Full article
19 pages, 8114 KiB  
Article
High Levels of Nutrients of Concern in Baby Foods Available in Europe That Contain Sugar-Contributing Ingredients or Are Ultra-Processed
Nutrients 2021, 13(9), 3105; https://doi.org/10.3390/nu13093105 - 03 Sep 2021
Cited by 21 | Viewed by 5194
Abstract
Introducing children to healthy and diverse complementary foods, either prepared at home or produced commercially, helps to establish taste preferences and good eating habits later in life. Assessing the nutrient profile of foods available commercially is key to informing consumers and policy makers. [...] Read more.
Introducing children to healthy and diverse complementary foods, either prepared at home or produced commercially, helps to establish taste preferences and good eating habits later in life. Assessing the nutrient profile of foods available commercially is key to informing consumers and policy makers. We used commercial data to provide an overview of the energy and nutrient content of 7 categories of foods intended for infants and young children that were launched or re-launched across 27 European countries from March 2017 to March 2021 (n = 3427). We also assessed the presence of sugars as added ingredients, and the foods’ level of processing, using the NOVA classification system. In total, 38.5% of the products contained at least one sugar-contributing ingredient; about 10% of products listed an added sugar, almost ¼ of the products listed a free sugar and finally about 20% of the products listed fruit and vegetable purees and powders as an ingredient. Half of the products had a ‘no added sugars’ positioning statement; among these, almost 35% had free sugars, fruit and vegetable purees and powders as added ingredients. With regard to processing classification, 46.3% of the products were minimally processed, 24.5% were processed and 29.2% ultra-processed. About half of all products had a ‘no artificial ingredient’ positioning statement; however, among these, 31.4% were ultra-processed. Our analysis showed that, within each food category, products with sugars as an added ingredient had a less desirable nutrient profile compared to those that did not have sugar-contributing ingredients. The results for level of processing were similar; in most food categories, ultra-processed foods had higher energy, fat, saturated fat, sugars and sodium content, and lower fibre content, compared to the minimally processed and processed ones. Full article
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10 pages, 1488 KiB  
Article
Towards a More Sustainable Nutrition: Complementary Feeding and Early Taste Experiences as a Basis for Future Food Choices
Nutrients 2021, 13(8), 2695; https://doi.org/10.3390/nu13082695 - 04 Aug 2021
Cited by 11 | Viewed by 4677
Abstract
The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the [...] Read more.
The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the consumption of vegetable, organic and minimally processed foods, as well as regional, seasonal and Fair-Trade products, reducing the ecological impact of the production chain. These eating habits could be established starting from the prenatal period and from infancy during the complementary feeding stage, aiding children to accept of a more variable diet in terms of flavor, taste and texture. In particular, the positive parental role model is an effective method for improving a child’s diet and behaviors. Two healthy plates representing a sustainable diet in early infancy, at 6 and 24 months, are here proposed, in line with the “Planetary Health Diet” approved by the EAT-Lancet Commission. Our work aims to highlight how a sustainable diet is possible since infancy, since the introduction of solid foods. Full article
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13 pages, 565 KiB  
Article
Associations between Infant Dietary Intakes and Liking for Sweetness and Fattiness Sensations in 8-to-12-Year-Old Children
Nutrients 2021, 13(8), 2659; https://doi.org/10.3390/nu13082659 - 30 Jul 2021
Cited by 3 | Viewed by 2032
Abstract
An exposure to sweetened and fatty foods early in life may be involved in high liking later in life. The objective is to investigate the association between dietary exposure to carbohydrate, sugars and fat in infancy, with liking for sweetness, fattiness and fattiness-and-sweetness [...] Read more.
An exposure to sweetened and fatty foods early in life may be involved in high liking later in life. The objective is to investigate the association between dietary exposure to carbohydrate, sugars and fat in infancy, with liking for sweetness, fattiness and fattiness-and-sweetness sensations at 8-to-12-year-old. Analyses were conducted on 759 French children from the EDEN mother-child cohort. Carbohydrate, sugar or fat intake, being a consumer of added sugars or added fats were assessed at 8 and 12 months using 3-day food records. The liking score (0–10) for the different sensations was assessed through an online child-completed questionnaire. Associations were tested by linear regressions adjusted for main confounders and the interaction with sex was tested. None of the early dietary exposure variables was related to fattiness liking. Carbohydrate intake at 8 months was positively but weakly associated with liking for sweetness-and-fattiness. In girls only, carbohydrate intake at 12 months was positively associated with liking for sweetness. Globally, no marked associations were observed between infant dietary exposure to sweet and fat and liking for sweetness and fattiness in young children. The positive link in girls between early carbohydrate exposure and later liking for sweetness needs to be confirmed in further studies. Full article
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14 pages, 530 KiB  
Article
The Perceptions and Needs of French Parents and Pediatricians Concerning Information on Complementary Feeding
Nutrients 2021, 13(7), 2142; https://doi.org/10.3390/nu13072142 - 22 Jun 2021
Cited by 8 | Viewed by 2869
Abstract
Appropriate complementary feeding (CoF) is the key to preventing childhood obesity and promoting long-term health. Parents must be properly informed through the CoF process. Pediatricians have opportunities to interact with parents during the CoF transition and influence parental feeding decisions. They can convey [...] Read more.
Appropriate complementary feeding (CoF) is the key to preventing childhood obesity and promoting long-term health. Parents must be properly informed through the CoF process. Pediatricians have opportunities to interact with parents during the CoF transition and influence parental feeding decisions. They can convey public health nutrition messages to parents. With the release of new CoF recommendations in France in 2019, and from the perspective of their conversion into official public health communication material, the aim of this study was to explore parents’ and pediatricians’ perceptions and needs regarding information on CoF. Two online surveys were disseminated to gather information on CoF communication and guidance: one for parents (n = 1001, January 2020); one for pediatricians (n = 301, October 2019). The results showed that the importance of CoF for children’s healthy growth was well recognized by both parents and pediatricians. Parents acknowledged pediatricians as the most influential source of advice; and pediatricians were aware of their responsibility in counselling parents on CoF. However, pediatricians neglected the fact that parents gave high trust to their personal network when looking for advice. The Internet was a well-recognized source of information according to all. Diverging from what pediatricians considered useful, parents were interested in practical advice for implementing CoF. This study highlights common expectations and points of divergence between parents’ needs and pediatricians’ perceptions of those needs with regard to CoF information. Full article
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16 pages, 1373 KiB  
Article
Are Homemade and Commercial Infant Foods Different? A Nutritional Profile and Food Variety Analysis in Spain
Nutrients 2021, 13(3), 777; https://doi.org/10.3390/nu13030777 - 27 Feb 2021
Cited by 10 | Viewed by 3633
Abstract
Complementary feeding (CF) is an important determinant of early and later life nutrition with great implications for the health status and the development of an adequate growth. Parents can choose between homemade foods (HMFs) and/or commercial infant foods (CIFs). There is no consistent [...] Read more.
Complementary feeding (CF) is an important determinant of early and later life nutrition with great implications for the health status and the development of an adequate growth. Parents can choose between homemade foods (HMFs) and/or commercial infant foods (CIFs). There is no consistent evidence as to whether HMFs provide a better nutritional profile and variety over CIFs. The aim of this study was to compare the nutritional profiles and food variety of HMFs versus CIFs in the Spanish market targeted for infants (6–11 months) and young children (12–18 months). Thirty mothers with their children aged 6 to 18 months were included in this cross-sectional study, following a 3-day weighed food diary of which HMFs were collected and chemically analyzed. HMFs meals for infant provided significantly lower energy, higher protein and higher fiber, for young children provided significantly higher protein and fiber than CIFs meals. HMFs fruit purees for infant shown significantly higher fiber and for young children provided higher energy than CIFs. HMFs meals contained a significantly greater number of different vegetables than CIFs meals (3.7 vs. 3.3), with carrot as the most frequently used in both. However, in CIFs fruit purees shown higher different fruits than HMFs, in both the banana was the fruit most frequently used. There was a predominance of meat and lack of oily fish and legumes in both HMFs and CIFs meals. HMFs and CIFs were equally characterized by a soft texture and yellow-orange colours. Importantly, our findings emphasize the need for clear guidelines for the preparation of HMFs as well as the promotion of food variety (taste and textures) in both HMFs and CIFs to suit infants’ and young children’s nutritional and developmental needs. Full article
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Review

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15 pages, 1604 KiB  
Review
Complementary Feeding and Iron Status: “The Unbearable Lightness of Being” Infants
Nutrients 2021, 13(12), 4201; https://doi.org/10.3390/nu13124201 - 23 Nov 2021
Cited by 14 | Viewed by 4155
Abstract
The complementary feeding (CF) period that takes place between 6 and 24 months of age is of key importance for nutritional and developmental reasons during the transition from exclusively feeding on milk to family meals. In 2021, a multidisciplinary panel of experts from [...] Read more.
The complementary feeding (CF) period that takes place between 6 and 24 months of age is of key importance for nutritional and developmental reasons during the transition from exclusively feeding on milk to family meals. In 2021, a multidisciplinary panel of experts from four Italian scientific pediatric societies elaborated a consensus document on CF, focusing in particular on healthy term infants. The aim was to provide healthcare providers with useful guidelines for clinical practice. Complementary feeding is also the time window when iron deficiency (ID) and iron deficiency anemia (IDA) are most prevalent. Thus, it is appropriate to address the problem of iron deficiency through nutritional interventions. Adequate iron intake during the first two years is critical since rapid growth in that period increases iron requirements per kilogram more than at any other developmental stage. Complementary foods should be introduced at around six months of age, taking into account infant iron status. Full article
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16 pages, 655 KiB  
Review
Which Milk during the Second Year of Life: A Personalized Choice for a Healthy Future?
Nutrients 2021, 13(10), 3412; https://doi.org/10.3390/nu13103412 - 27 Sep 2021
Cited by 7 | Viewed by 3325
Abstract
Nutrition in early life is a crucial element to provide all essential substrates for growth. Although this statement may appear obvious, several studies have shown how the intake of micro and macronutrients in toddlers differs a lot from the recommendations of scientific societies. [...] Read more.
Nutrition in early life is a crucial element to provide all essential substrates for growth. Although this statement may appear obvious, several studies have shown how the intake of micro and macronutrients in toddlers differs a lot from the recommendations of scientific societies. Protein intake often exceeds the recommended amount, while the intake of iron and zinc is frequently insufficient, as well as Vitamin D. Nutritional errors in the first years of life can negatively impact the health of the child in the long term. To date, no clear evidence on which milk is suggested during the second year of life is yet to be established. In this study, we compare the nutrient profiles of cow’s milk and specific formulas as well as nutritional risks in toddlers linked to growth and childhood obesity development. The purpose of this review is to resume the latest clinical studies on toddlers fed with cow’s milk or young children formula (YCF), and the potential risks or benefits in the short and long term. Full article
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14 pages, 812 KiB  
Review
Epigenetics and Modulations of Early Flavor Experiences: Can Metabolomics Contribute to Prevention during Weaning?
Nutrients 2021, 13(10), 3351; https://doi.org/10.3390/nu13103351 - 24 Sep 2021
Cited by 1 | Viewed by 2034
Abstract
The significant increase in chronic non-communicable diseases has changed the global epidemiological landscape. Among these, obesity is the most relevant in the pediatric field. This has pushed the world of research towards a new paradigm: preventive and predictive medicine. Therefore, the window of [...] Read more.
The significant increase in chronic non-communicable diseases has changed the global epidemiological landscape. Among these, obesity is the most relevant in the pediatric field. This has pushed the world of research towards a new paradigm: preventive and predictive medicine. Therefore, the window of extreme plasticity that characterizes the first stage of development cannot be underestimated. In this context, nutrition certainly plays a primary role, being one of the most important epigenetic modulators known to date. Weaning, therefore, has a crucial role that must be analyzed far beyond the simple achievement of nutritional needs. Furthermore, the taste experience and the family context are fundamental for future food choices and can no longer be underestimated. The use of metabolomics allows, through the recognition of early disease markers and food-specific metabolites, the planning of an individualized and precise diet. In addition, the possibility of identifying particular groups of subjects at risk and the careful monitoring of adherence to dietary therapy may represent the basis for this change. Full article
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Other

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23 pages, 1127 KiB  
Systematic Review
Do Vegetarian Diets Provide Adequate Nutrient Intake during Complementary Feeding? A Systematic Review
Nutrients 2022, 14(17), 3591; https://doi.org/10.3390/nu14173591 - 31 Aug 2022
Cited by 14 | Viewed by 14427
Abstract
During the complementary feeding period, any nutritional deficiencies may negatively impact infant growth and neurodevelopment. A healthy diet containing all essential nutrients is strongly recommended by the WHO during infancy. Because vegetarian diets are becoming increasingly popular in many industrialized countries, some parents [...] Read more.
During the complementary feeding period, any nutritional deficiencies may negatively impact infant growth and neurodevelopment. A healthy diet containing all essential nutrients is strongly recommended by the WHO during infancy. Because vegetarian diets are becoming increasingly popular in many industrialized countries, some parents ask the pediatrician for a vegetarian diet, partially or entirely free of animal-source foods, for their children from an early age. This systematic review aims to evaluate the evidence on how vegetarian complementary feeding impacts infant growth, neurodevelopment, risk of wasted and/or stunted growth, overweight and obesity. The SR was registered with PROSPERO 2021 (CRD 42021273592). A comprehensive search strategy was adopted to search and find all relevant studies. For ethical reasons, there are no interventional studies assessing the impact of non-supplemented vegetarian/vegan diets on the physical and neurocognitive development of children, but there are numerous studies that have analyzed the effects of dietary deficiencies on individual nutrients. Based on current evidence, vegetarian and vegan diets during the complementary feeding period have not been shown to be safe, and the current best evidence suggests that the risk of critical micronutrient deficiencies or insufficiencies and growth retardation is high: they may result in significantly different outcomes in neuropsychological development and growth when compared with a healthy omnivorous diet such as the Mediterranean Diet. There are also no data documenting the protective effect of vegetarian or vegan diets against communicable diseases in children aged 6 months to 2–3 years. Full article
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20 pages, 1106 KiB  
Systematic Review
Complementary Feeding Caregivers’ Practices and Growth, Risk of Overweight/Obesity, and Other Non-Communicable Diseases: A Systematic Review and Meta-Analysis
Nutrients 2022, 14(13), 2646; https://doi.org/10.3390/nu14132646 - 26 Jun 2022
Cited by 7 | Viewed by 4028
Abstract
Several institutions propose responsive feeding (RF) as the caregivers’ relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers’ feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, [...] Read more.
Several institutions propose responsive feeding (RF) as the caregivers’ relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers’ feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, whereas this SR compares different CFPs only in healthy children (4–24 months) from industrialized countries. Clinical questions were about the influence of different CFPs on several important outcomes, namely growth, overweight/obesity, risk of choking, dental caries, type 2 diabetes (DM2), and hypertension. The literature review does not support any Baby Led Weaning’s or Baby-Led Introduction to SolidS’ (BLISS) positive influence on children’s weight–length gain, nor their preventive effect on future overweight/obesity. RF-CFPs can result in adequate weight gain and a lower incidence of overweight/obesity during the first two years of life, whereas restrictive styles and coercive styles, two kinds of non-RF in CF, can have a negative effect, favoring excess weight and lower weight, respectively. Choking risk: failure to supervise a child’s meals by an adult represents the most important risk factor; no cause–effect relation between BLW/BLISS/RF/NRCF and choking could be found. Risks of DM2, hypertension, and caries: different CFPs cannot be considered as a risky or preventive factor for developing these conditions later in life. Full article
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14 pages, 945 KiB  
Systematic Review
Timing of Complementary Feeding, Growth, and Risk of Non-Communicable Diseases: Systematic Review and Meta-Analysis
Nutrients 2022, 14(3), 702; https://doi.org/10.3390/nu14030702 - 08 Feb 2022
Cited by 7 | Viewed by 3219
Abstract
No consensus currently exists on the appropriate age for the introduction of complementary feeding (CF). In this paper, a systematic review is conducted that investigates the effects of starting CF in breastfed and formula-fed infants at 4, 4–6, or 6 months of age [...] Read more.
No consensus currently exists on the appropriate age for the introduction of complementary feeding (CF). In this paper, a systematic review is conducted that investigates the effects of starting CF in breastfed and formula-fed infants at 4, 4–6, or 6 months of age (i) on growth at 12 months of age, (ii) on the development of overweight/obesity at 3–6 years of age, (iii) on iron status, and (iv) on the risk of developing (later in life) type 2 diabetes mellitus (DM2) and hypertension. An extensive literature search identified seven studies that evaluated the effects of the introduction of CF at the ages in question. No statistically significant differences related to the age at which CF is started were observed in breastfed or formula-fed infants in terms of the following: iron status, weight, length, and body mass index Z-scores (zBMI) at 12 months, and development of overweight/obesity at 3 years. No studies were found specifically focused on the age range for CF introduction and risk of DM2 and hypertension. Introducing CF before 6 months in healthy term-born infants living in developed countries is essentially useless, as human milk (HM) and formulas are nutritionally adequate up to 6 months of age. Full article
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19 pages, 334 KiB  
Concept Paper
Recommendations on Complementary Feeding as a Tool for Prevention of Non-Communicable Diseases (NCDs)—Paper Co-Drafted by the SIPPS, FIMP, SIDOHaD, and SINUPE Joint Working Group
Nutrients 2022, 14(2), 257; https://doi.org/10.3390/nu14020257 - 07 Jan 2022
Cited by 11 | Viewed by 3990
Abstract
Adequate and balanced nutrition is essential to promote optimal child growth and a long and healthy life. After breastfeeding, the second step is the introduction of complementary feeding (CF), a process that typically covers the period from 6 to 24 months of age. [...] Read more.
Adequate and balanced nutrition is essential to promote optimal child growth and a long and healthy life. After breastfeeding, the second step is the introduction of complementary feeding (CF), a process that typically covers the period from 6 to 24 months of age. This process is, however, still highly controversial, as it is heavily influenced by socio-cultural choices, as well as by the availability of specific local foods, by family traditions, and pediatrician beliefs. The Società Italiana di Pediatria Preventiva e Sociale (SIPPS) together with the Federazione Italiana Medici Pediatri (FIMP), the Società Italiana per lo Sviluppo e le Origine della Salute e delle Malattie (SIDOHaD), and the Società Italiana di Nutrizione Pediatrica (SINUPE) have developed evidence-based recommendations for CF, given the importance of nutrition in the first 1000 days of life in influencing even long-term health outcomes. This paper includes 38 recommendations, all of them strictly evidence-based and overall addressed to developed countries. The recommendations in question cover several topics such as the appropriate age for the introduction of CF, the most appropriate quantitative and qualitative modalities to be chosen, and the relationship between CF and the development of Non-Communicable Diseases (NCDs) later in life. Full article
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