Search Results (22)

Complementary feeding influences infant growth and health. Māori and Pacific infants in Aotearoa New Zealand experience disproportionate nutrition-related disease, yet complementary feeding data are limited. Caregivers of 625 infants (7–10 months) completed a questionnaire on timing of introduction, baby-led weaning (BLW), and baby food pouch use. Ethnicity was total response; infants not Māori or Pacific were classified as ‘other’. Complementary foods were introduced at around six months for 56.5% of Māori, 62.2% of Pacific, and 80.9% of others; before five months for 40.5%, 34.2%, and 17.3%. BLW prevalence was 29.2% (Māori), 17.1% (Pacific), and 27.3% (other). Although pouches were uncommon when complementary feeding began, by 7–10 months about two-thirds of Māori and Pacific infants were fed pouches sometimes or frequently. Frequent pouch use with mostly or always nozzle feeding occurred in 12.2% of Māori infants, 12.2% of Pacific infants, and 2.7% of other infants. Vegetables and purée were the most common first food and texture. By six months, over half consumed red meat and about half consumed iron-fortified baby rice. These feeding practices have implications for nutrition-related health inequities among Māori and Pacific infants, highlighting the need for culturally centered public health approaches to support whānau with feeding. Full article

Background/Objectives: To assess associations between dietary fibre intake, adiposity, and odds of metabolic syndrome in Pacific and New Zealand European women. Methods: Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18–45 years) were recruited based on normal (18–24.9 kg/m²) and obese (≥30 kg/m²) BMIs. Body fat percentage (BF%), measured using whole body DXA, was subsequently used to stratify participants into low (<35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute (NCI) method, involving a five-day food record and semi-quantitative food frequency questionnaire. Fasting blood was analysed for glucose and lipid profile. Metabolic syndrome was assessed with a harmonized definition. Results: NZ European women in both the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (low-BF%: median 23.7 g/day [25–75-percentile, 20.1, 29.9]; high-BF%: 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; and 17.8 [15.0, 20.8]; both p < 0.001). The main source of fibre was discretionary fast foods for Pacific women and whole grain breads and cereals for NZ European women. A regression analysis controlling for age, socioeconomic deprivation, ethnicity, energy intake, protein, fat, and total carbohydrate intake showed an inverse association between higher fibre intake and BF% (β= −0.47, 95% CI = −0.62, −0.31, p < 0.001), and odds of metabolic syndrome (OR = 0.91, 95% CI = 0.84, 0.98, p = 0.010) among both Pacific and NZ European women (results shown for both groups combined). Conclusions: Low dietary fibre intake was associated with increased metabolic disease risk. Pacific women had lower fibre intakes than NZ European women. Full article

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

The National Healthy Food and Drink Policy (NHFDP) was developed to promote healthy food environments for the New Zealand District Health Board (DHB) staff and visitors. The policy classifies food and drinks as red, amber, or green and sets benchmarks for the proportions of red, amber, and green foods that should be available on-site. The HYPE (Healthy Policy Evaluation) study is the first national evaluation of the implementation and impact of the NHFDP. We designed an electronic audit tool to collect detailed food and drink data across a range of food settings (vending machines and all food outlets) at New Zealand DHBs and some government agencies. The electronic audit tool collects all the information required to classify food and drinks under the NHFDP (photographs of foods and drinks, item weight/volume, energy and nutrient content, ingredient composition, and Health Star Rating). The web-based tool was created using Drupal (web content management framework) and pilot tested. The tool is now in use by the HYPE team in DHBs across New Zealand. Data collection commenced in March 2021 and has been completed for nine DHBs (5700 products) so far. Audit results detailing the proportion of red, amber, and green food items available at all participating institutions will be available in late 2022. Ongoing stakeholder feedback and requirements have been incorporated throughout the design process and used to improve the audit tool. This feedback has informed key lessons such as agreeing the tool’s aims and objectives collectively with stakeholders/potential end users, pilot testing the tool prior to use, and ensuring the tool is simple and accessible for all end-users. This new electronic food setting audit tool has successfully facilitated comprehensive and standardised data collection across a range of retail settings. Full article

Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. However, studies reporting barriers and facilitators experienced by food vendors and caterers in providing healthy and nutritious foods and drinks have not been collated and synthesised, representing a significant gap in workplace health promotion knowledge. Our objective was to systematically synthesise evidence on barriers and facilitators relative to the implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces internationally. Nine scientific databases, nine grey literature sources, and government websites in key English-speaking countries were searched between April and June 2021. All identified records (n = 8559) were assessed for eligibility. Studies reporting barriers and facilitators were included irrespective of the study design and methods used, but they were excluded if they were published before the year 2000 or in a non-English language. Methodological strengths and limitations of the included studies were assessed with the CASP Qualitative Studies Checklist. Drawing on a thematic synthesis approach, primary findings were generated through research question-led coding and theme development. Forty-one studies were eligible for inclusion, and they were mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centres, and government agencies. Generally, poorly reported data collection and analysis methods were observed. Preliminary findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Generated codes indicate that barriers and facilitators fall into five broad categories of financial ramifications, availability of healthier products, existence of supporting tools and resources, institutional leadership support, and communication between stakeholders. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested in or engaging in healthy food and drink policy development and implementation. Full article

Research shows the shaping of food choices often occurs at home, with the family widely recognised as significant in food decisions. However, in this digital age, our eating habits and decision-making processes are also determined by smartphone apps, celebrity chefs, and social media. The ‘COVID Kai Survey’ online questionnaire assessed cooking and shopping behaviours among New Zealanders during the 2020 COVID-19 ‘lockdown’ using a cross-sectional study design. This paper examines how sources of food choice inspirations (cooking-related advice and the reasons for recipe selection) are related to dietary patterns before and during the lockdown. Of the 2977 participants, those influenced by nutrition and health experts (50.9% before; 53.9% during the lockdown) scored higher for the healthy dietary pattern. Participants influenced by family and friends (35% before; 29% during the lockdown) had significantly higher scores for the healthy and the meat dietary patterns, whereas participants influenced by celebrity cooks (3.8% before; 5.2% during the lockdown) had significantly higher scores in the meat dietary pattern. There was no evidence that associations differed before and during the lockdown. The lockdown was related to modified food choice inspiration sources, notably an increase in ‘comforting’ recipes as a reason for recipe selection (75.8%), associated with higher scoring in the unhealthy dietary pattern during the lockdown. The lockdown in New Zealand saw an average decrease in nutritional quality of diets in the ‘COVID Kai Survey’, which could be partly explained by changes in food choice inspiration sources. Full article

Food waste is a crisis of our time, yet it remains a data gap in Aotearoa New Zealand’s (NZ’s) environmental reporting. This research contributes to threshold values on NZ’s food waste and seeks to understand the impact of the 2020 COVID-19 lockdown on household food waste in NZ. The data presented here form part of the ‘Covid Kai Survey’, an online questionnaire that assessed cooking and food planning behaviours during the 2020 lockdown and retrospectively before lockdown. Of the 3028 respondents, 62.5% threw out food ‘never’/‘rarely’ before lockdown, and this number increased to 79.0% during lockdown. Participants who wasted food less frequently during lockdown were more likely to be older, work less than full-time, and have no children. During lockdown, 30% and 29% of those who ‘frequently’ or ‘sometimes’ struggled to have money for food threw out food ‘sometimes or more’; compared with 20% of those who rarely struggled to have money for food (p < 0.001). We found that lower levels of food waste correlated with higher levels of cooking confidence (p < 0.001), perceived time (p < 0.001), and meal planning behaviours (p < 0.001). Understanding why food waste was generally considerably lower during lockdown may inform future initiatives to reduce food waste, considering socio-economic and demographic disparities. Full article

Wholegrain flour produced by roller-milling is predominantly comprised of fine particles, while stoneground flour tends to have a comparatively smaller proportion of fine particles. Differences in flour particle size distribution can affect postprandial glycaemia in people with type 2 diabetes and postprandial insulinaemia in people with and without type 2 diabetes. No prior studies have investigated the effect of wholegrain flour particle size distribution on glycaemic or insulinaemic response among people with impaired glucose tolerance or risk factors for type 2 diabetes. In a randomised crossover study, we tested the 180-min acute glycaemic and insulinaemic responses to three wholegrain breads differing in flour particle size and milling method: (1) fine roller-milled flour, (2) fine stoneground flour, and (3) coarse stoneground flour. Participants (n = 23) were males and females with risk factors for type 2 diabetes (age 55–75 y, BMI >28 kg/m², completing less than 150 min moderate to vigorous intensity activity per week). Each test meal provided 50 g available carbohydrate, and test foods were matched for energy and macronutrients. There was no significant difference in blood glucose iAUC (incremental area under the curve) between the coarse stoneground flour bread and the fine stoneground flour bread (mean difference −20.8 (95% CI: −51.5, 10.0) mmol·min/L) and between the coarse stoneground flour bread and the fine roller-milled flour bread (mean difference −23.3 (95% CI: −57.6, 11.0) mmol·min/L). The mean difference in insulin iAUC for fine stoneground flour bread compared with the fine roller-milled flour bread was −6.9% (95% CI: −20.5%, 9.2%) and compared with the coarse stoneground flour bread was 9.9% (95% CI: −2.6%, 23.9%). There was no evidence of an effect of flour particle size on postprandial glycaemia and insulinaemia among older people with risk factors for type 2 diabetes, most of whom were normoglycaemic. Full article