E. Riva

Factors associated with initiation and duration of breastfeeding in Italy

To evaluate factors associated with initiation and duration of breastfeeding in Italy, 1601 (73%) respondents among 2192 randomly selected mothers were interviewed within 1 mo of delivery. Mothers who started breastfeeding (85%) were followed‐up for 12 mo. A compliance rate of 100% was obtained. At multiple logistic regression analysis, mother having been breastfed herself (p<0.01), nursing guidance in the maternity ward (p= 0.01) and higher social class (p= 0.03) were positively associated with initiation of breastfeeding. We found that 42%, 19%, 10% and 4% mothers were still breastfeeding at 3, 6, 9 and 12 mo after delivery, respectively. Cox multiple regression analysis showed a negative association between duration of breastfeeding and pacifier use (p<0.01), and a positive association with a higher level of maternal education (p= 0.04). Formula supplementation in the maternity ward (given to 30% of infants) was associated with a shorter duration of exclusive breastfeeding (p = 0.03). Mothers need support with breastfeeding, particularly those from lower social backgrounds and with lower levels of education. Early use of the pacifier should be discouraged.

Early macronutrient intake and overweight at five years of age.

OBJECTIVE: To examine the influence of the macronutrient intake in early life on the development of overweight in children.DESIGN AND SUBJECTS: An ongoing longitudinal study including 147 randomized healthy children followed up from birth.MEASUREMENTS: Anthropometric parameters were measured at birth, 1 and 5 y of age. Dietary habits at the age of 1 and 5  were assessed by age-adjusted food-frequency questionnaires and 24 h recalls. Parents’ body mass index (BMI) was also recorded.RESULTS: Parental overweight was observed for 51% children. The prevalence of overweight at the age of 5 y was higher in children with than without parental overweight (37.3% vs 8.3%, P<0.0001). Five-year old overweight children had a higher percentage intake of proteins at the age of 1 y than non overweight children (22% vs 20%, P=0.024) and lower intake of carbohydrates (44% vs 47%, P=0.031). Multiple logistic analysis confirmed that protein intake at 1 y of age was associated with overweight at 5 y (P=0.05). In children born from overweight mothers, prevalence of overweight at the age of 5 y tended to be higher in bottle-fed than in breast-fed ones (62.5% vs 23.3%, P=0.08).CONCLUSION: Parental overweight is a major risk factor for childhood overweight in the first years of life, but an early high protein intake may also influence the development of adiposity.

Feeding practices of infants through the first year of life in Italy

Aim: To investigate infant feeding practices through the first year of life in Italy, and to identify factors associated with the duration of breastfeeding and early introduction of solid foods. Methods: Structured phone interviews on feeding practices were conducted with 2450 Italian‐speaking mothers randomly selected among women who delivered a healthy‐term singleton infant in November 1999 in Italy. Interviews were performed 30 d after delivery and when the infants were aged 3, 6, 9 and 12 mo. Type of breastfeeding was classified according to the WHO criteria. Results: Breastfeeding started in 91.1% of infants. At the age of 6 and 12mo, respectively, 46.8% and 11.8% of the infants was still breastfed, 68.4% and 27.7% received formula, and 18.3% and 65.2% were given cows milk. Solids were introduced at the mean age of 4.3 mo (range 1.6–6.5 mo). Introduction of solids occurred before age 3 and 4 mo in 5.6% and 34.2% of infants, respectively. The first solids introduced were fruit (73.1%) and cereals (63.9%). The main factors (negatively) associated with the duration of breastfeeding were pacifier use (p > 0.0001), early introduction of formula (p > 0.0001), lower mothers age (p > 0.01) and early introduction of solids (p= 0.05). Factors (negatively) associated with the introduction of solids foods before the age of 3 mo were mother not having breastfed (p > 0.01), early introduction of formula (p > 0.01), lower infant bodyweight at the age of 1 mo (p= 0.05) and mother smoking (p= 0.05).

Growth patterns of breast fed and formula fed infants in the first 12 months of life: an Italian study

AIM To compare the growth patterns of breast fed and formula fed Italian infants in the first 12 months of life using World Health Organisation (WHO) reference data. METHODS The growth patterns of 73 breast fed infants (36 male, 37 female) and 65 formula fed infants (35 male, 30 female) were compared. Solid foods were introduced with the same weaning schedules from the 5th month in both groups. The weight for age (WA), length for age (LA), and weight for length (WL) z scores (National Center for Health Statistics–WHO data) were calculated at birth, 1, 2, 3, 4, 6, 9, and 12 months. RESULTS Breast fed infants had the highest z scores (WA, WL) at birth. Breast fed groups had significantly higher growth indices at 1 month (WA, LA), 2 months (WA) and 3 months (WA, LA) of age. Compared to breast fed groups, formula fed infants showed significantly higher WA z score changes in the 1–2, 2–3, 3–4, and 4–6 month intervals. LA z score changes were higher for breast fed infants at 0–1 month and for the formula fed infants at 4–6 months. In the 6–12 month interval growth indices progressively increased for the formula fed infants and declined for infants breast fed for longer (12 months). The 0–12 month changes in WA, LA, and WL z scores were positive for formula fed infants and negative for the 12 month breast fed group. Nevertheless, the 12 month breast fed group showed an absolute WA z score just below 0 (mean (SEM) −0.04 (0.26)) at 12 months. CONCLUSION The growth pattern of breast fed and formula fed Italian infants differs in the first 12 months of life. This questions the validity of current reference values for monitoring the growth of breast fed infants. Growth indices in breast fed groups, high at birth and closer than expected to the reference at 12 months, may reflect differences in genetic factors, intrauterine conditions, or both.

Effect of hepatitis C genotype on mother-to-infant transmission of virus☆☆☆★★★

We evaluated vertical transmission of hepatitis C virus (HCV) in 37 pregnant women, 20 of whom also had human immunodeficiency virus (HIV) antibody. The HCV subtypes 1a and 3a were prevalent among pregnant women with HIV infection. Infection with HCV was transmitted from 30.7% of the 13 mothers with HCV ribonucleic acid (RNA) and HIV antibody and from 25% of the 8 with HCV RNA alone. No mother with HCV antibody but no HCV RNA transmitted HCV to her infant. Subtypes 1b and 3a seemed to be the most common HCV genotypes transmitted.

Heat treatment modifies the allergenicity of beef and bovine serum albumin

The effect of heat on the allergenicity of beef and bovine serum albumin was investigated among 10 toddlers skin prick test (SPT)‐positive to raw and cooked beef. The meat‐allergy diagnosis was confirmed during double‐blind, placebo‐controlled food challenge (DBPCFC) with 180 g of beef cooked for 5 min at 100°C. SPT with homogenized and freeze‐dried beef, and heated and unheated bovine serum albumin were performed. Both heated and unheated bovine serum albumin, homogenized beef, and freeze‐dried beef were used in trial DBPCFC. All children were SPT‐positive to unheated bovine serum albumin. Seven were positive to heated bovine serum albumin, one to freeze‐dried beef, and none to homogenized beef. DBPCFCs were negative for homogenized beef and freeze‐dried beef, positive for unheated bovine serum albumin in five patients, and positive for heated albumin in four children. We conclude that heating reduces sensitization to beef and bovine serum albumin but does not abolish reactivity to albumin under home conditions. However, industrially heat‐treated and sterilized homogenized beef and freeze‐dried beef may be suitable substitutes in beef‐allergic childrens diets.

Breakfast: A Good Habit, not a Repetitive Custom

In developed countries, obesity is the most frequent nutritional disorder, and overweight and obesity prevalences have increased whilst physical activity and breakfast consumption have declined. There is growing scientific interest in the possible role of breakfast in weight control and in factors such as appetite control, dietary quality and reduced risk for chronic diseases. The current article reviews the literature and discusses how the breakfast ‘environment’ and the composition of breakfast meals might be improved, particularly in children, so as to maintain the breakfast eating habit throughout life. Recommendations are proposed to encourage children to keep eating breakfast and the nutritional composition of the ‘American breakfast’ and two types of Mediterranean ‘cereal breakfasts’ are compared. We also propose a new breakfast type for children and adolescents that is based on chocolate hazelnut spread within a mixed breakfast type in order to reinforce positive experiences.

Phenylketonuria: Dietary and therapeutic challenges

SummaryPKU subjects need special attention in the definition of optimal supplementation of nutrients, which may be insufficient in relation to the type of diet and may otherwise manifest symptoms of deficit. In particular, it is necessary to pay great attention to the long-chain polyunsaturated fatty acid (LC-PUFA) levels in relation to correct development of the central nervous system. On the basis of numerous beneficial effects currently known, a permanent supplementation with LC-PUFAs, in particular with docosahexaenoic acid, should be considered. Moreover, new formulas, Phe-free peptides, and ‘modulated’ amino acid preparations might help in preventing nutritional deficiencies and imbalances, with the ultimate aim of improving growth. New strategies—such as supply of tetrahydrobiopterin—need to be optimized in terms of targets, patients and expected outcomes.

Tolerance to a rice hydrolysate formula in children allergic to cow's milk and soy

Background Even hydrolysed cows milk formulae may retain residual allergens and there are few nutritional options for children with cows milk allergy (CMA) who also react to soy.

How much protein is safe

BACKGROUND:Since breastfeeding and human milk seem to prevent, while high dietary proteins in the first 2 y of life seem to promote, later overweight, questions have been raised on the safe levels of proteins in the early years. How much protein (as a percentage of total calorie intake) is safe?METHODS:Revision of available data on the protein content of human milk, protein intake in the first 2 y of life and their association with body mass development.RESULTS:We should move from the figure of 7–8% in the 4-month exclusively breastfed infants up to the maximum acceptable levels of 14% in 12–24-month-old infants. When protein supply represents less than 6% and energy is limited, fully breastfed infants are likely to enter a status of negative nutrient balance. Over the limit of 14% energy from proteins in the 6–24 months period, some mechanisms may begin to operate, leading young children towards an early adiposity rebound and overweight development, beyond any genetic predisposition. Preliminary data seem to indicate a causal role for whole cows milk proteins.CONCLUSION:We suggest maintaining breastfeeding as long as possible, and, in case human milk is insufficient, to introduce infant formulas, appropriate for age, up to 18–24 months, in order to keep protein intakes in the safe range of 8–12% within a diet adequate in energy and balanced as far as macronutrients.