Chelsea Mauch

An Early Feeding Practices Intervention for Obesity Prevention

OBJECTIVE: Report long-term outcomes of the NOURISH randomized controlled trial (RCT), which evaluated a universal intervention commencing in infancy to provide anticipatory guidance to first-time mothers on “protective” complementary feeding practices that were hypothesized to reduce childhood obesity risk. METHODS: The NOURISH RCT enrolled 698 mothers (mean age 30.1 years, SD = 5.3) with healthy term infants (51% female). Mothers were randomly allocated to usual care or to attend two 6-session, 12-week group education modules. Outcomes were assessed 5 times: baseline (infants 4.3 months); 6 months after module 1 (infants 14 months); 6 months after module 2 (infants 2 years) and at 3.5 and 5 years of age. Maternal feeding practices were self-reported using validated questionnaires. BMI Z-score was calculated from measured child height and weight. Linear mixed models evaluated intervention (group) effect across time. RESULTS: Retention at age 5 years was 61%. Across ages 2 to 5 years, intervention mothers reported less frequent use of nonresponsive feeding practices on 6 of 9 scales. At 5 years, they also reported more appropriate responses to food refusal on 7 of 12 items (Ps ≤ .05). No statistically significant group effect was noted for anthropometric outcomes (BMI Z-score: P = .06) or the prevalence of overweight/obesity (control 13.3% vs intervention 11.4%, P = .66). CONCLUSIONS: Anticipatory guidance on complementary feeding resulted in first-time mothers reporting increased use of protective feeding practices. These intervention effects were sustained up to 5 years of age and were paralleled by a nonsignificant trend for lower child BMI Z-scores at all postintervention assessment points.

Predictors of and reasons for pacifier use in first-time mothers: an observational study

BackgroundThe use of pacifiers is commonplace in Australia and has been shown to be negatively associated with breastfeeding duration. In order to influence behaviour related to the use of pacifiers it is important to understand the reasons for their use. The primary aim of this observational study was to investigate who (if anyone) advises first-time mothers to give a pacifier and the reasons for which they first give (or try to give) a pacifier to their infant. Additionally, this study investigated the predictors of pacifier use and the relationship between pacifier use and breastfeeding duration.MethodsIn total, 670 Australian first-time mothers recruited as part of the NOURISH trial completed a questionnaire regarding infant feeding and pacifier use.ResultsPacifiers were introduced by 79% of mothers, of whom 28.7% were advised to use a pacifier by their mother/mother-in-law with a further 22.7% being advised by a midwife. The majority of mothers used a pacifier in order to soothe their infant (78.3%), to help put them to sleep (57.4%) and to keep them comforted and quiet (40.4%). Pacifiers given to infants before four weeks (adjHR 3.67; 95%CI 2.14-6.28) and used most days (adjHR 3.28; 95%CI 1.92-5.61) were significantly associated with shorter duration of breastfeeding.ConclusionsThis study identifies an opportunity for educating new mothers and their support network, particularly their infants grandmothers, with regards to potential risks associated with the early and frequent use of a pacifier, and alternative methods for soothing their infant, in order to reduce the use of pacifiers and their potentially negative effect on breastfeeding duration.

Child dietary and eating behavior outcomes up to 3.5 years after an early feeding intervention: The NOURISH RCT.

To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early feeding intervention (concealed allocation, assessor masked randomized controlled trial).

Dietary intake in Australian children aged 4-24 months: consumption of meat and meat alternatives.

Meat/meat alternatives (M/MA) are key sources of Fe, Zn and protein, but intake tends to be low in young children. Australian recommendations state that Fe-rich foods, including M/MA, should be the first complementary foods offered to infants. The present paper reports M/MA consumption of Australian infants and toddlers, compares intake with guidelines, and suggests strategies to enhance adherence to those guidelines. Mother-infant dyads recruited as part of the NOURISH and South Australian Infants Dietary Intake studies provided 3 d of intake data at three time points: Time 1 (T1) (n 482, mean age 5·5 (SD 1·1) months), Time 2 (T2) (n 600, mean age 14·0 (SD 1·2) months) and Time 3 (T3) (n 533, mean age 24 (SD 0·7) months). Of 170 infants consuming solids and aged greater than 6 months at T1, 50 (29%) consumed beef, lamb, veal (BLV) or pork on at least one of 3 d. Commercial infant foods containing BLV or poultry were the most common form of M/MA consumed at T1, whilst by T2 BLV mixed dishes (including pasta bolognaise) became more popular and remained so at T3. The processed M/MA increased in popularity over time, led by pork (including ham). The present study shows that M/MA are not being eaten by Australian infants or toddlers regularly enough; or in adequate quantities to meet recommendations; and that the form in which these foods are eaten can lead to smaller M/MA serve sizes and greater Na intake. Parents should be encouraged to offer M/MA in a recognisable form, as one of the first complementary foods, in order to increase acceptance at a later age.

Beverage intake of Australian children and relationship with intake of fruit, vegetables, milk and body weight at 2, 3.7 and 5 years of age: Beverage intake of Australian children aged two to five years

AIM Describe the type and amount of beverages consumed by Australian children at age 2, 3.7 and 5; investigate the longitudinal relationship between intake of sweet beverages with fruits and vegetables or milk/alternatives, and body mass index (BMI) z-score. METHODS Mothers in the NOURISH trial completed a single 24-hour recall of their childs intake, at age 2 (n = 515), 3.7 (n = 426) and 5 (n = 405). Anthropometry was measured by study staff. At each time point, proportion of children consuming at least one beverage on 24-hour recall from the following groups was determined; essential-cows milk/alternatives, breast milk; non-essential-formula, sweet beverages. For consumers, intake (grams) of each beverage and proportion total estimated energy intake was calculated. The longitudinal relationship between intake of sweet beverages, and fruit and vegetable intake (g/kg body weight), with BMI z-score at 2, 3.7 and 5 years was examined using structural equation modelling. A second model investigated relationship with intake of milk/alternatives. RESULTS Sweet beverages were consumed by 38, 55 and 47% of children at each time point. Intake of sweet beverages strongly correlated between two and five years; however, intake was not associated with BMIz and did not appear to displace fruit and vegetable intake. Intake of cows milk declined over time and was negatively associated with intake of sweet beverages at two and five years. CONCLUSIONS Tracking of intake over time supports the notion that childrens early experience of sweet tastes is a strong predictor of future intake. Limiting exposure to sweet beverages in early childhood remains an important strategy in the development of healthy food preferences and promotion of dietary quality.

Validation testing of a short food‐group‐based questionnaire to assess dietary risk in preschoolers aged 3–5 years

To the Editor, Accurate measurement of dietary intake is crucial for understanding the relationship between diet and chronic disease, monitoring trends in predictors of health and determining intervention effectiveness. Traditional dietary assessment methods such as food records and recalls are subject to substantial error whereas short questionnairestyle methods enable rapid food intake reporting, increased cooperation and completion, and derivation of food-based data that are useful for monitoring dietary guideline compliance. Dietary assessment in young children is particularly challenging due to variation in diet across brief time periods. Thus age-specific assessment tools are required. The reliable and valid short food-based Toddler Dietary Questionnaire (TDQ) was adapted for use with Australian preschoolers. This study aimed to determine the test–retest reliability, relative validity and convergent validity of this new Preschooler Dietary Questionnaire (PDQ). Primary caregivers of preschoolers aged 3–5 years, recruited via Flinders University newsletter advertisements and a study-specific Facebook page, completed a two-stage online survey. Stage 1 comprised a demographic questionnaire and the 19-item PDQ (PDQ1). Stage 2 (completed 2.1 1.0 weeks later) comprised a second PDQ (PDQ2) and a validated 54-item Food Frequency Questionnaire (FFQ). The PDQ and TDQ are the same apart from the use of age-appropriate portion size categories. Intake is scored against a dietary risk criterion (0–100; higher score = higher risk) (Table 1) and scores categorised into: low (0–24); moderate (25–49); high (50–74) and very high (75–100) dietary risk. Data were analysed using SPSS version 22.0 (IBM SPSS Statistics, IBM Corporation, Armonk, New York, USA). Dietary risk scores (sections 1–3; total) were examined for test–retest reliability (PDQ1 vs PDQ2) and relative validity (PDQave ((PDQ1 + PDQ2)/2) vs FFQ) at the individual (intraclass correlations (ICC), Pearson’s correlations; low ≤0.50; moderate 0.51–0.69; high ≥0.70) and group level (paired t-tests). To assess the strength of agreement between the two methods (PDQave and FFQ), Bland–Altman plots were constructed, assessed visually and linear regression analysis performed to test for systematic bias. Cross classification of subjects into dietary-risk categories was determined and standard linear regression employed to determine convergent validity by assessing the relationship of dietary risk scores with socio-demographic characteristics and Body Mass Index (BMI) z-score, adjusting for covariates. Seventy-four parents (35.5 4.1 years, 81% universityeducated) of preschoolers (54% female, 3.7 0.6 years, BMIz 0.31 1.02, average Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) score 1003.8 58.66) completed all study questionnaires. Mean total dietary risk scores ranged from 32.7 9.2 (PDQ2) to 35.1 9.7 (FFQ) (Table 1; i.e. ‘moderate’ risk). Total and section risk scores from each PDQ administration were highly correlated (ICC 0.83–0.92) yet statistically different for section 1 (mean bias 4.1, 95% CI 0.5, 7.7, P = 0.027) and total (mean bias 1.5, 95%CI 0.1, 3.0, P = 0.040) risk scores (Table 1). Most (82%) participants were correctly classified (18%, adjacent category) upon each PDQ administration. PDQave and FFQ dietary risk scores were highly correlated for sections 1 and 3 and total risk scores (all r ≥ 0.80), but not for section 2 (r = 0.67) (Table 1). Despite no statistically significant difference between the PDQave and FFQ for section scores (mean bias range: −1.0 section 3 to −2.8 section 1), there was for total risk scores (mean bias −1.6, 95% CI −2.9, −0.4, P = 0.009). Bland– Altman plots (Figure 1) show that the PDQave provides a higher estimate of risk than the FFQ for section and total risk scores (i.e. positive mean differences). Most measurements fell within wide 95% limits of agreement (total risk scores, LOA −11.9, 8.6) and there was no significant linear trend for the fitted regression line (Table 1). Participants were classified into the same (80%) or adjacent (20%) category upon administration of each tool. PDQave scores were significantly negatively associated with the number of people per household (β −0.32, 95% CI −6.69, −0.59, P = 0.020) but not with preschoolers’ BMIz score (β −0.09, 95% CI −0.02, −0.04, P = 0.512). The PDQ is the first tool of its kind for use in Australian preschoolers as it assesses whole of diet intake (core/non-core food groups), allowing comprehensive evaluation of intake against dietary guidelines and thus assessment of dietary risk. Despite significant differences between PDQ-derived total dietary risk scores upon two administrations and on comparison with scores derived from a FFQ, the differences were small (1.5 and −1.6 respectively, out of 100 points). Bland–Altman plots revealed arguably wide 95% LOA but no systematic bias between the two tools, indicating good group-level agreement. The high proportion of participants classified into the same risk category highlights the usefulness of the PDQ as a screening instrument to identify those at highest risk requiring intervention. However, the lack of association between PDQ-derived dietary risk scores and preschoolers’ BMIz score, consistent with findings from Accepted January 2018

Serve sizes and frequency of food consumption in Australian children aged 14 and 24 months

Objective: To describe the dietary intake of a sample of Australian children.

Consistency of Food Preferences in Australian Children from 2 to 5 Years of Age

While it is generally accepted that food habits established during infancy will track into later childhood, longitudinal analysis of children’s food preferences is rare. This paper examines whether maternal-reported child food preferences at five years of age are the same as that reported at two years; and identifies any patterns of change from twoto fiveyears. Mothers in the Australian NOURISH trial reported child food preferences at two and five years of age. A four point scale was utilised ‘like’, ‘neither like or dislike’, ‘dislike’, ‘never tried’. The proportion of children having the same preference at the two time points was calculated (95%CI) for 48 foods (cereals, 4; vegetables, 20; fruit, 14; meat/alternatives, 6; dairy, 4). For foods where ≤50% children had consistent preferences, the pattern of food preference change was determined. For 40/48 foods, more than half of the children were reported to have the same preference at two years of age, and three years later, at age five. Foods for which ≤50% children had the same preference at both ages were high-sugar breakfast cereals, zucchini, mushrooms, eggplant, spinach, lettuce, cabbage and celery. Findings reinforce the importance of promoting a consistent message regarding early and frequent exposure to a variety of healthy foods, particularly during the first 2 years of life, as the preferences established in these early years are likely to be maintained over time.