Search Results (25)

Objective: Most wet commercial infant foods are now sold in squeezable ‘pouches’. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children. Methods: In this observational cross-sectional study of 933 young New Zealand children (6.0 months–3.9 years), pouch use was assessed by a questionnaire (‘frequent’ use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards. Results: The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Māori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (−580 kJ [−1094, −67]), but infants (115 [−35, 265]) and toddlers (−206 [−789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use. Conclusions: These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI. Full article

Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at “around 6 months of age”: “frequent” baby food pouch use (five+ times per week) and “full baby-led weaning” (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67–3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45–1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition. Full article

Infant feeding guidelines provide evidence-based recommendations to support optimal infant health, growth, and development, and exploring adherence to guidelines is a useful way of assessing diet quality. The aim of this study was to determine adherence to the recently updated Ministry of Health “Healthy Eating Guidelines for New Zealand Babies and Toddlers (0–2 years old)”. Data were obtained from First Foods New Zealand, a multicentre observational study of 625 infants aged 7.0–10.0 months. Caregivers completed two 24-h diet recalls and a demographic and feeding questionnaire. Nearly all caregivers (97.9%) initiated breastfeeding, 37.8% exclusively breastfed to around six months of age, and 66.2% were currently breastfeeding (mean age 8.4 months). Most caregivers met recommendations for solid food introduction, including appropriate age (75.4%), iron-rich foods (88.3%), puréed textures (80.3%), and spoon-feeding (74.1%). Infants consumed vegetables (63.2%) and fruit (53.9%) more frequently than grain foods (49.5%), milk and milk products (38.6%), and meat and protein-rich foods (31.8%). Most caregivers avoided inappropriate beverages (93.9%) and adding salt (76.5%) and sugar (90.6%). Our findings indicated that while most infants met the recommendations for the introduction of appropriate solid foods, the prevalence of exclusive breastfeeding could be improved, indicating that New Zealand families may need more support. Full article

Baby food pouches are becoming an increasingly popular way to assist the transition from breast milk or infant formula to solid foods, both in New Zealand (NZ) and worldwide. These pouches have overtaken the market in NZ supermarkets, with 63.9% of total baby foods sold in 2021 being in pouch form. While most pouches are aimed at infants, some are pitched to an older age group, and it is possible that some toddlers and preschoolers continue to consume baby food pouches well beyond 12 months of age. Despite concerns raised by a number of health agencies, there has been almost no research undertaken on the use of “baby” food pouches by children, and related health effects. Therefore, this study aims to describe how “baby” food pouches are being used by young children in NZ. In Young Foods NZ, an observational cross-sectional study, 287 participants with children aged 1–3.9 years completed a feeding questionnaire about the child’s “baby” food pouch consumption including frequency, method of use, and setting. The majority (85.4%) of children had used a pouch at some time in their life; however, only 11.1% were current ‘frequent’ pouch users (i.e., used baby food pouches five or more times a week). Sixty-five percent of pouch users always consumed the contents by sucking straight from the nozzle. Chair (22.8%), highchair (25.7%), and while “on the go” (23.1%) were the most common locations where pouches were consumed. Overall, while most young children had tried a “baby” food pouch at some point in their life, relatively few were considered frequent pouch users. These findings suggest pouches are not contributing substantially to most young NZ children’s diets. However, over half of pouch users sucked the contents directly from the nozzle, and this may have implications for dental health and oral motor skill development. Full article

Household food insecurity, defined in New Zealand (NZ) as a ‘limited or uncertain availability of nutritionally adequate and safe foods or limited ability to acquire acceptable foods in a socially acceptable way’, is a serious public health concern associated with poorer diet quality and nutritional deficiencies. Preventing food insecurity in infancy is crucial because adequate nutrition is essential for normal infant growth and development. Household food insecurity was investigated in the First Foods NZ study, a cross-sectional study of families with infants aged 6.9–10.1 months in Auckland and Dunedin. A NZ-specific questionnaire consisting of eight validated food security indicator statements relating to household financial constraint over the previous 12 months was administered. The participants’ responses were scored using a total scoring protocol developed in the study. Cut-offs were applied to the total scores to create categories of food insecurity (secure, moderately insecure, severely insecure), and each household (n = 604) was classified into a category. In total, 17.4% (n = 105) of the households were moderately food insecure and 7.6% (n = 46) were severely food insecure. Of the food security indicators, the participants most frequently reported that the variety of foods the household was able to eat was limited by a lack of money (18.5% sometimes; 3.3% often), feeling stressed because of not having enough money for food (16.6% sometimes; 3.2% often), or feeling stressed because they could not provide the food they wanted for social occasions (13.9% sometimes; 3.0% often). Severe food insecurity was most prevalent in participants of Māori or Pasifika ethnicity, <25 years of age, not in work or on leave from work, or for whom school was their highest level of education. One quarter (25%) of the families experienced a degree of food insecurity, highlighting the need for dignified solutions that support all NZ families to acquire foods that are nutritious, affordable, and culturally acceptable to them. Full article

Transitioning from milk to complementary food (CF) is a critical time for infants, with the non-timely introduction associated with poorer health outcomes. We aimed to describe the timing of the introduction of CF and its sociodemographic associations in an ethnically diverse cohort of urban-dwelling infants. The timing of CF introduction and sociodemographic characteristics (ethnicity, maternal education, parity, deprivation index, infant sex) were collected by questionnaire when infants were 7.0–10.0 months. Early CF introduction was defined as ≤4 months and late as ≥7 months of age. Of 625 infants, 131 (20.1%) were identified as Māori, 82 (13.2%) as Pasifika, and 450 (72.1%) as other. The mean (SD) age of CF introduction was 4.9 (1.1) months for both Māori and Pasifika infants and 5.3 (0.8) months for other. 6.9% of Māori infants were introduced to CF before 4 months, 33.6% at 4 months, and 3.1% at 7 months. For Pasifika, the percentages were 9.8%, 24.4%, and 3.7%, respectively. For others, percentages were lower at <1%, 16.7%, and 1.8%, respectively. Using logistic regression analysis, Māori and Pasifika had higher odds of early CF introduction for infants with mothers whose highest education was secondary school (Māori: 3.8 ([95% CI] 1.5, 9.8); Pasifika: 3.3 (1.1, 10.3)). The odds of early CF introduction for other infants were higher for those with mothers whose highest education was secondary school (2.1 (1.2, 3.5)), who lived in areas of high deprivation (1.8 (1.0, 3.2)), and whose infant sex was male (1.7 (1.1, 2.9)). Parity was not associated with early CF introduction for any group. Most infants in all groups were introduced to CF between 4 and 6 months of age and over half at around 6 months of age. A small proportion of infants were introduced before 4 months. This research identifies groups that would benefit from more targeted infant feeding support. Full article

The importance of breastfeeding and the appropriate introduction of complementary feeding are well recognised. Our objective was to investigate adherence to breastfeeding and complementary feeding guidelines in New Zealand (NZ) infants aged 7.0 to 10.0 months, based on the Ministry of Health’s healthy eating guidelines for NZ babies and toddlers (0–2 years), which recommend exclusive breastfeeding to “around” six months of age, at which time, complementary feeding should be initiated. This investigation was conducted within the First Foods New Zealand (FFNZ) study. From 2020 to 2022, FFNZ recruited an ethnically diverse sample of 625 infants living in Auckland and Dunedin. Participants completed two study visits, which included two 24-hour diet recalls and the completion of demographic and feeding questionnaires. Infants and caregivers were aged 8.4 (0.8) months (mean (SD)) and 32.7 (4.9) years, respectively. The majority (98%) of caregivers were the infant’s mother. More than half of the caregivers had a university education (64.9%) and were not currently employed (66.9%). Approximately half the caregivers were first-time mothers (48.7%). In FFNZ, exclusive breastfeeding was defined as exclusive breastfeeding to at least five and less than seven months of age. Within FFNZ, 43.2% of infants met this guideline. At the time of participation, 66.2% continued to breastfeed. The introduction of solid food at around six months of age was achieved by 75.2% of participants. Most infants were provided puréed foods (80.3%) and were spoon fed (74.1%) when starting solid foods. The findings indicate that most FFNZ infants met guidelines for the age of introduction, texture, and method of feeding complementary foods. However, our guidelines for breastfeeding in NZ were not met to the same extent, indicating the need for further support for NZ whānau to achieve to current breastfeeding recommendations. Full article

Optimal nutrition during early childhood is essential to support physiological and cognitive development. However, data on nutrient intakes and associations with socioeconomic deprivation are lacking in young children living in New Zealand (NZ). As a component of Young Foods NZ, a multi-centre cross-sectional study, this research aims to determine nutrient intakes and their associations with socioeconomic deprivation in young NZ children aged 1–3.9 years. Dietary intake data (two 24 h diet recalls) and socioeconomic deprivation (NZDep2018) were collected from 289 children living in Auckland, Wellington, and Dunedin. The multiple source method was utilised to determine the usual dietary intake. All participants exceeded the Estimated Average Requirement (EAR) for protein (12 g/day), with a mean (SD) intake of 45.5 (10.4) g/day. Using the full probability approach, the prevalence of inadequate intake for iron was 38.2%, with an overall mean (SD) intake of 6.6 (2.2) mg/day. The prevalence of inadequate intake for fibre (<14 g/day) was 54.3%, with a mean (SD) intake of 14.0 (4.4) g/day. Saturated fat contributed 14%, and total sugars contributed 23% of the total energy intake. Living in a neighbourhood of low deprivation (NZDep1–3) is a significant predictor of higher dietary fibre and iron intakes and lower fat intake for young children compared with those living in deprivation (NZDep4–10). In this cohort, a high proportion of children do not have the best start in life due to the suboptimal intake of iron and dietary-fibre-containing foods, and the disproportionate consumption of saturated fat and sugar-rich foods. Children living in areas of deprivation are particularly at risk. Effective policies are needed to reduce these disparities and ensure that all children have equitable access to healthy and nutritious foods. Full article

Three metabolite patterns have previously shown prospective inverse associations with the risk of aggressive prostate cancer within the European Prospective Investigation into Cancer and Nutrition (EPIC). Here, we investigated dietary and lifestyle correlates of these three prostate cancer-related metabolite patterns, which included: 64 phosphatidylcholines and three hydroxysphingomyelins (Pattern 1), acylcarnitines C18:1 and C18:2, glutamate, ornithine, and taurine (Pattern 2), and 8 lysophosphatidylcholines (Pattern 3). In a two-stage cross-sectional discovery (n = 2524) and validation (n = 518) design containing 3042 men free of cancer in EPIC, we estimated the associations of 24 dietary and lifestyle variables with each pattern and the contributing individual metabolites. Associations statistically significant after both correction for multiple testing (False Discovery Rate = 0.05) in the discovery set and at p < 0.05 in the validation set were considered robust. Intakes of alcohol, total fish products, and its subsets total fish and lean fish were positively associated with Pattern 1. Body mass index (BMI) was positively associated with Pattern 2, which appeared to be driven by a strong positive BMI-glutamate association. Finally, both BMI and fatty fish were inversely associated with Pattern 3. In conclusion, these results indicate associations of fish and its subtypes, alcohol, and BMI with metabolite patterns that are inversely associated with risk of aggressive prostate cancer. Full article

Globally, a recent phenomenon in complementary feeding is the use of squeezable baby food pouches. However, some health agencies have raised concerns about their possible long-term health effects. The aim of this study was to describe parental perceptions of the use of baby food pouches during complementary feeding (i.e., the transition from an entirely milk-based diet to solid foods) using a netnographic analysis of discussions on publicly available forums. In this study, the community was parents of young children. Six parenting forums were identified through a Google search using defined selection criteria. Discussion threads relating to baby food pouches were collected and imported into NVivo12 for thematic analysis via inductive reasoning. Perceptions of baby food pouches fell within two broad categories—benefits and concerns. The most commonly reported themes related to benefits were: convenience, health, baby enjoys, variety, and cost; whereas the most common concerns reported were: health, cost, lack of dietary exposure, dependence, and waste. Many parents reported both benefits and concerns. Once research has determined the long-term effect of using pouches on infants’ health regarding eating habits, nutritional status, growth, and development, the findings of this study can inform educational strategies to either encourage or discourage their use. Full article

Dietary patterns (DPs) explore one’s whole diet and can be used to investigate associations between dietary intake and obesity. This study investigates the DPs of community-dwelling adults (65–74 years, 36% male) and associations with body mass index (BMI), body fat percent (BF%) and macronutrient intake. Dietary data (validated 109-item food frequency questionnaire) collected in the Research Eating, Activity, and Cognitive Health (REACH) study (n = 367) were collapsed into 57 food groups. The percent of macronutrient intake contributing to energy intake was calculated. BMI was calculated using measured height and weight. BF% was measured using Dual-energy X-ray Absorptiometry. Confounding factors (age, sex, physical activity and index of multiple deprivation) were collected using a questionnaire. The mean percent of energy intake from protein (18%) was within, carbohydrate (40%) below, and both total and saturated fat (36%, 15%) were above acceptable macronutrient distribution ranges. Using principal component analysis, three DPs were extracted explaining 18% of the variation in the diet: Mediterranean-style (vegetables, avocados/olives, alliums, nuts/seeds, shellfish, white/oily fish, berries and fruit), Western (processed meat/fish, sauces/condiments, cakes/biscuits/puddings and meat pies/hot chips) and prudent (legumes, soy-based foods, whole grains and carrots). Using multiple linear regression and adjusting for confounding factors, the Western DP was positively associated with BMI (β = 0.87; 95% confidence interval (CI) 0.20, 1.54; p = 0.01) and BF% (β = 0.86; 95% CI 0.12, 1.60; p = 0.02). The prudent DP was negatively associated with BMI (β = −0.65; 95% CI −1.14, −0.16; p = 0.01) and BF% (β = −0.66; 95% CI −1.20, −0.12; p = 0.02). The Mediterranean-style DP was not associated with BMI (β = −0.49; 95% CI −0,99, 0.01; p = 0.06) or BF% (β = −0.49; 95% CI −1.04, 0.06; p = 0.08). The percent of energy from carbohydrate increased and total and saturated fat decreased as Western and prudent DP scores increased. Fibre intake also increased as prudent DP scores increased. Western and prudent, but not Mediterranean-style, dietary patterns and their macronutrient intakes explain some variation in body composition. Full article

Vegetarianism appears to be increasing in Western countries. The health benefits of following a vegetarian diet include improved cardiovascular health, lower body mass, and a decreased risk of non-communicable diseases. However, restrictive food selection can result in suboptimal intakes of critical nutrients, increasing the risk of deficiencies. This is particularly important for female adolescents who have increased nutritional requirements. Most of the information on vegetarian diets and adolescent health was collected decades ago. Much less is known about the micronutrient status of modern female adolescent vegetarians. We aimed to compare the nutritional and biochemical status of vegetarian and non-vegetarian adolescent females in New Zealand. Adolescent females aged 15–18 years were recruited from eight locations throughout New Zealand. Micronutrient intakes were assessed via two 24 h diet recalls, which were adjusted to represent usual intakes. Blood samples were analysed for haemoglobin, and serum concentrations of ferritin, soluble transferrin receptor, zinc, selenium, retinol binding protein, folate, B12, C-reactive protein, and alpha-1-acid glycoprotein. Of the 182 participants who provided a blood sample, 15% self-identified as vegetarian (n = 27). Vegetarians had significantly lower daily mean intakes of vitamin B12 (p < 0.001), zinc (p < 0.001) and selenium (p = 0.039). On average, vegetarians had 3.1% (95% CI −5.8 to −0.4, p = 0.025) lower haemoglobin, 9.5% (95% CI −15.4 to −3.2, p = 0.004) lower selenium, and 80.5% (95% CI 45.7 to 123.7, p < 0.001) higher serum folate concentrations. Serum B12 concentrations were also lower (−18.2% (95% CI −33.7 to 0.9)), although not statistically significantly different (p = 0.060). The prevalence of anaemia, zinc, and selenium deficiency among vegetarians (15%, 50% and 54%, respectively) was higher than for non-vegetarians (5%, 21%, and 30%, respectively). Female adolescent vegetarians may be at increased risk of deficiency of nutrients commonly found in animal products, including iron, selenium and zinc. It is important for vegetarian adolescent females to follow dietary practices that enhance micronutrient intake and absorption. Full article

Globally, the value sales of baby food pouches increased by 28% in December 2013–2014. Although baby food pouches are an increasingly popular choice for parents, a number of health agencies have raised concerns about their possible long-term health effects. The wealth of online parenting forums provides easily accessed opportunities for parents to discuss a wide range of topics on food and nutrition, including the use of baby food pouches. This study aimed to describe parental perceptions of the use of baby food pouches during complementary feeding (i.e., the transition from an entirely milk-based diet to solid foods) using a netnographic analysis of discussions on publicly available forums. Netnography is an innovative methodology which uses internet-based communications on social networking sites as a data source to understand a community. In this study, the community was parents of young children. Six parenting forums were identified through a Google search using defined selection criteria. Discussion threads relating to baby food pouches were collected and imported into NVivo 12 for thematic analysis via inductive reasoning. Perceptions of baby food pouches fell within two broad categories—benefits and concerns. The most commonly reported themes related to benefits were: convenience, health, baby enjoyment, variety, and cost; and those related to concerns were: health, cost, lack of dietary exposure, dependence, and waste. Many parents reported both benefits and concerns. To conclude, the convenience of baby food pouches was the primary benefit reported, although the parents also had concerns, particularly regarding health effects. Research is still needed to determine whether baby food pouches provide a net benefit or harm to infant health. Once this has been determined, communication to parents to either encourage or discourage their use is likely to be more effective if it takes into account the benefits and concerns reported here by parents. Full article

Dietary intake is an important predictor of health and disease outcomes. This cross-sectional study evaluated the relative validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) for assessing energy and nutrient intake in older adults. Dietary data were collected 2018–2019 in Auckland, New Zealand from a convenience sample of community-dwelling adults (65–74 years, n = 294, 37% male) using a 109-item self-administered FFQ at baseline (FFQ1) and four weeks later to assess reproducibility. FFQ1 was compared to a four-day food record to determine relative validity. Agreement between dietary assessment tools was assessed for both raw and energy-adjusted nutrient intakes using paired t-tests, correlation coefficients, weighted kappa statistic, Bland–Altman plots, and linear regression analysis. Energy adjustments moderately improved the relative validity and reproducibility for most nutrients. For energy and energy-adjusted nutrient intakes, the mean correlation coefficients were 0.38 (validity) and 0.65 (reproducibility); the mean weighted kappa statistics were 0.27 (validity) and 0.51 (reproducibility). A significant slope of bias was present in 54% (validity) and 25% (reproducibility) of Bland–Altman plots. The Researching Eating, Activity, and Cognitive Health (REACH) FFQ has acceptable relative validity and good reproducibility for ranking nutrient intakes in older New Zealand adults, but is less suitable for assessing absolute nutrient intakes. Full article

There has been an important shift in the New Zealand infant food market over the past decade, with the majority of complementary foods now sold in “pouches”. Along with the increasing market share of commercial infant food pouches internationally, there have been growing concerns about their nutritional quality. However, research examining the nutritional quality of these pouches compared to other forms of commercial infant foods in New Zealand has not been undertaken. Nor have any studies reported the free sugars or added sugars content of these foods. To address this knowledge gap, a cross-sectional survey of infant foods sold in New Zealand supermarkets was conducted in 2019–2020. Recipes and nutrient lines were developed for the 266 foods identified (133 food pouches). The energy, iron, vitamin B12, total sugars, free sugars, and added sugars content of infant food pouches and other forms of commercial infant foods per 100 g were compared, both within food groups and by age group. Infant food pouches contained similar median amounts of energy, iron, and vitamin B12 to other forms of commercial infant foods but contained considerably more total sugars (8.4 g/100 g vs. 2.3 g/100 g). However, median free sugars and added sugars content was very low across all food groups except for “dairy” and “sweet snacks”. All “dry cereals” were fortified with iron whereas none of the infant food pouches were. Therefore, consuming food pouches to the exclusion of other commercial infant foods may place infants at risk of iron deficiency if they do not receive sufficient iron from other sources. Full article