Alison Parrett

Intestinal flora during the first months of life: new perspectives.

Increasing awareness that the human intestinal flora is a major factor in health and disease has led to different strategies to manipulate the flora to promote health. The complex microflora of the adult is difficult to change in the long term. There is greater impact of diet on the infant microflora. Manipulation of the flora particularly with probiotics has shown promising results in the prevention and treatment of diarrhoea and allergy. Before attempting to change the flora of the infant population in general, a greater understanding of the gut bacterial colonisation process is required. The critical stages of gut colonisation are after birth and during weaning. Lactic acid bacteria dominate the flora of the breast-fed infant. The formula-fed infant has a more diverse flora. The faeces of the breast-fed infant contain mainly acetic and lactic acid whereas the formula fed-infant has mainly acetic and propionic acid. Butyric acid is not a significant component in either group. The formula-fed infant also has higher faecal ammonia and other potentially harmful bacterial products. The composition of the microflora diversifies shortly before and particularly after weaning. The flora of the formula-fed infant develops more quickly than that of the breast-fed infant. Before embarking on any strategy to change the flora, the following questions should be considered: Should we retain a breast-fed style flora with limited ability to ferment complex carbohydrates? Can pro- and prebiotics achieve a flora with adult characteristics but with more lactic acid bacteria in weaned infants? Are there any health risks associated with such manipulations of the flora?

Faecal short chain fatty acids in breast-fed and formula-fed babies.

Edwards CA, Parrett AM, Balmer SE, Wharton BA. Faecal short chain fatty acids in breast‐fed and formula‐fed babies. Acta Pædiatr 1994;83:459–62. Stockholm. ISSN 0803–5253

Dietary fibre in infancy and childhood

There is very little evidence for the effects of dietary fibre in young children and current dietary guidelines are based on assumptions and data extrapolated from studies in adults. The first years of life may be critical for the establishment of a healthy colonic microflora, as well as good eating habits. The lack of clear and well-founded guidelines for the intake of dietary fibre in childhood may hinder both factors. The fears that a high-fibre diet in children < 5 years of age will lead to growth faltering and mineral imbalance are not well supported in the literature, especially for children in the developed world. Indeed, with the rising levels of obesity, fibre intake may be of benefit in reducing energy intake. A low-fibre diet may also be implicated in the aetiology of childhood constipation and appendicitis. The latest proposals for the definition of dietary fibre include oligosaccharides, which may act as prebiotics. There are potential health benefits of including oligosaccharides in the diets of infants and children, but more research is needed to consider the long-term effects. The immature intestine of the infant may also result in a greater amount of starch entering the colon during weaning, and this starch would now be considered dietary fibre under the new definitions. Much new research is needed to allow adequate recommendations for the intake of dietary fibre in childhood based on data collected in appropriate age-groups.

Nutritional content of infant commercial weaning foods in the UK

Background and aims Health professionals are frequently asked to advise on aspects of complementary feeding. This study aimed to describe the types of commercial infant foods available in the UK and provide an overview of their taste, texture and nutritional content in terms of energy, protein, carbohydrates, fat, sugar, iron, sodium and calcium. Method All infant foods produced by four main UK manufacturers and two more specialist suppliers were identified during October 2010–February 2011. Nutritional information for each product was collected from manufacturers’ websites, products in store and via direct email enquiry. Results Of the 479 products identified in this study 364 (79%) were ready-made spoonable foods; 44% (201) were aimed at infants from 4 months, and 65% of these were sweet foods. The mean (SD) energy content of ready-made spoonable foods was 282 (59) kJ per 100 g, almost identical to breast milk (283(16) kJ per 100 g). Similar spoonable family foods were more nutrient dense than commercial foods. Commercial finger foods were more energy dense, but had very high sugar content. Conclusions The UK infant food market mainly supplies sweet, soft, spoonable foods targeted from age 4 months. The majority of products had energy content similar to breast milk and would not serve the intended purpose of enhancing the nutrient density and diversity of taste and texture in infants’ diets.

Evaluation of a cooking skills programme in parents of young children – a longitudinal study

OBJECTIVE To evaluate longitudinally the effectiveness of a cooking programme on self-reported confidence about cooking skills and food consumption patterns in parents of young children. DESIGN An evaluation of cooking programmes delivered by National Health Service (NHS) community food workers using a single group pre-test/post-test repeated measures design. A shortened version of a validated questionnaire at baseline, post intervention and 1-year follow-up determined confidence in cooking using basic ingredients, following a simple recipe, tasting new foods, preparing and cooking new foods on consumption of ready meals, vegetables and fruit. SETTING Deprived communities in Ayrshire and Arran, Scotland. SUBJECTS Parents of nursery age children, 97 % were female and <45 years old. RESULTS One hundred and two participants had completed baseline and post-intervention questionnaires. Forty-four participants contacted by telephone completed a follow-up questionnaire. In participants who completed all questionnaires (n 44), median confidence in four aspects of cooking increased significantly from baseline to post intervention (P < 0·001) but was retained at 1-year follow-up only for following a simple recipe and preparing and cooking new foods. Improved food consumption patterns were reported from baseline to post intervention (ready-meal consumption reduced from 2-4 times/week to 1 time/week, P < 0·001; vegetable consumption increased from 5-6 times/week to 1 time/d, P < 0·001; fruit consumption increased from 5-6 times/week to 1 time/d, P < 0·001) and remained at 1-year follow-up. CONCLUSIONS The cooking programmes appeared to improve cooking confidence and food consumption patterns in the target group and some of these changes were retained after 1 year.

Protein-degradation products and bacterial enzyme activities in faeces of breast-fed and formula-fed infants

The aim of the present study was to determine the effects of age and diet (breast milk, formula milk and weaning diet) on metabolic activities in faecal samples from infants aged 1 week to 1 year, and to compare these findings with activities found in samples from adults. Such activities can provide valuable information on functional changes in the microbiota that may have significance for the health of the host. Fresh faecal samples were collected from forty-four breast-fed infants (twenty-four males, twenty females) and thirteen formula-fed infants (three males, ten females) throughout the first year of life. The samples were analysed for protein-breakdown products, including the faecal concentrations of NH3, phenol and p-cresol, and faecal bacterial enzyme activities. There was wide individual variation in all variables measured; however, the values in infants were substantially lower then those found in adults. In pre-weaned infants, faecal NH3 concentration and beta-glucuronidase activity were the only endpoints that were significantly different in breast-fed and formula-fed infants (P<0.001 and P<0.05 respectively). This was not apparent after weaning. There was a significant difference between the breast-fed and formula-fed weaned groups and their pre-weaned counterparts only for NH3 (P<0.05). beta-Glucuronidase activity and phenol concentration were significantly (P<0.01) greater in weaned breast-fed infants compared with pre-weaned breast-fed infants. No differences were observed between pre-weaned and weaned formula-fed infants for any of the variables except for NH3 concentration. It can be concluded from the present study that there are significant differences in two faecal characteristics between breast- and formula-fed infants and that changes occur as the infants grow older and are weaned onto solid foods.

A human flora-associated rat model of the breast-fed infant gut

Objectives Bacterial colonization of the infant gut may have important influences on the development of gastrointestinal, respiratory, and allergic disease. Early diet is a major determinant of the gut microflora. It is very difficult to carry out studies in human infants that can investigate the interaction of diet, flora, and mucosa. In this study we have developed an infant human flora-associated (IHFA) rat model to allow such investigation. Methods Germ-free infant rats were infected with fecal bacteria from exclusively breast-fed infants and were maintained on a modified infant formula for 8 weeks. The fecal and cecal contents were collected and compared with feces of breast-fed infants for bacterial populations, bacterial metabolites, and enzymes and for the ability to inhibit adhesion of pathogenic bacteria to human mucosal cells. Results The IHFA cecum and feces were dominated by lactic acid bacteria, Bifidobacterium, and lactobacilli, which were representative of the infant feces. The fecal short-chain fatty acid profile was dominated by acetic and lactic acid in a similar manner to human infant feces. Other bacterial metabolites were similar to those of the human infant. Rat intestinal samples were able to inhibit the adhesion of pathogens to mucosal cells, but to a lesser extent than the human samples. Conclusions This IHFA infant model of the intestinal flora of the breast-fed infant is considered valid for studying the effect of diet on bacterial colonization and metabolism.

Evaluation of the “Eat Better Feel Better” Cooking Programme to Tackle Barriers to Healthy Eating

We evaluated a 6-week community-based cooking programme, “Eat Better Feel Better”, aimed at tackling barriers to cooking and healthy eating using a single-group repeated measures design. 117 participants enrolled, 62 completed baseline and post-intervention questionnaires, and 17 completed these and a 3–4 months follow-up questionnaire. Most participants were female, >45 years, and socioeconomically deprived. Confidence constructs changed positively from baseline to post-intervention (medians, scale 1 “not confident” to 7 “very confident”): “cooking using raw ingredients” (4, 6 p < 0.003), “following simple recipe” (5, 6 p = 0.003), “planning meals before shopping” (4, 5 p = <0.001), “shopping on a budget (4, 5 p = 0.044), “shopping healthier food” (4, 5 p = 0.007), “cooking new foods” (3, 5 p < 0.001), “cooking healthier foods” (4, 5 p = 0.001), “storing foods safely” (5, 6 p = 0.002); “using leftovers” (4, 5 p = 0.002), “cooking raw chicken” (5, 6 p = 0.021), and “reading food labels” (4, 5 p < 0.001). “Microwaving ready-meals” decreased 46% to 39% (p = 0.132). “Preparing meals from scratch” increased 48% to 59% (p = 0.071). Knowledge about correct portion sizes increased 47% to 74% (p = 0.002). Spending on ready-meals/week decreased. Follow-up telephone interviewees (n = 42) reported developing healthier eating patterns, spending less money/wasting less food, and preparing more meals/snacks from raw ingredients. The programme had positive effects on participants’ cooking skills confidence, helped manage time, and reduced barriers of cost, waste, and knowledge.

Are infant/toddler commercial ready to eat foods in the UK market meeting the European Commission Directives for relevant nutrients?

The composition of early infant diet may have a direct impact on metabolic pathways and health during adulthood (1) . This has important public health consequences as poor diet is associated with chronic disease which is currently a major topic of concern for the UK population. Since early food exposures determine later life food and health choices (2) , it is crucial to ensure that products provided for our youngest consumers are at a gold standard of nutrition. The NHS Infant Feeding Survey of 2005 showed that 85% of mothers are most likely to introduce their babies to commercially prepared foods (3) . Concerns have been raised regarding the nutritional quality of commercially prepared baby foods; in particular sugar and salt have been under scrutiny in Canada (4) . Similar concerns have been raised in the UK but little research has dealt with this issue. The aim of our study was to investigate the nutritional content of commercially prepared baby foods for infants and toddlers in the UK and examine whether they met the regulations of the European Union Commission Directive 2006/125/EC (5) on processed cereal based food and baby foods for infants and young children. A sub-objective was to investigate the number of ingredients in the products and to observe if any products contained any of sugar, salt, vitamins and corn flour as added ingredients. All foods and drinks from the major infant and toddler foods except infant formulae and milks were selected (n = 512) and nutritional information retrieved from package labels and manufacturer’s websites. The 6 brands investigated were: Heinz (n = 108), Cow & Gate (n = 120), Hipp Organic (n = 125), Organix (n = 60), Ella’s Kitchen (n = 42) and Boots (n = 57) which are the main manufacturing brands in the UK. Quantities of seven nutrients were determined (protein, carbohydrate, sugar, fat, sodium, iron and calcium) using a classification based on cereal-based or non cereal-based groups as stated by the EC Directive and these were compared with regulation limits set in the Directive to determine whether products complied. Results found that 55 products were out with the regulations (11%). There were no concerns regarding the amount of protein, carbohydrate and iron in products. Only 3 products (0.5%) exceeded the fat regulations and 5 (1%) exceeded sodium regulations. Sugars and calcium were the major concerns as 9 (1.7%) products exceed maximum sugar limits and 36 (7%) products were out with calcium requirements according to the regulations. Organix were the only brand out of the 6 investigated to have all products within the EU regulations. The brands which added one or more of the extra ingredients investigated were Heinz, Cow & Gate, Hipp Organic and Boots. Relevant finding are that 14 (13%) Heinz products have added sugar and 2 (1.8%) have added salt. A large number of the Hipp Organic products contained added salt (n = 43, 34%) and 5 (4%) have added sugars. Cow & Gate products have vitamins and sugar added to 13 (11%) of their products. Eight (14%) of Boots’ products contained sugars and 1 (1.7%) contained salt. We concluded that despite clear regulations and guarantees that these are closely monitored, infant and toddler weaning foods do not appear to be closely monitored as products exceeding regulation amounts are currently on sale in the UK market. Our results also raised concerns whether these ‘added’ ingredients are needed in these products, of special concern are added salt and sugar.