Katherine Younger

Factors Associated With Duration of Breastfeeding in Ireland Potential Areas for Improvement

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

Maternal health behaviours during pregnancy in an Irish obstetric population and their associations with socio-demographic and infant characteristics

Background/Objectives:To examine the prevalence and combined occurrence of peri-conceptional folic acid (FA) supplement use, smoking and alcohol consumption during pregnancy in a sample of women in Dublin, and determine the factors associated with these health behaviours.Subjects/Methods:A prospective observational study (2004–2006) involving the recruitment of 491 pregnant women from antenatal clinics in a Dublin maternity hospital, with postpartum follow-up of 450 eligible mothers. Data on FA use, maternal smoking and alcohol consumption patterns during pregnancy were collected from the antenatal patient-administered questionnaire, which was completed by participants, and returned to the investigator on the day of recruitment.Results:The median gestational age of women at recruitment was 36 weeks. A combined 24.2% of mothers commenced FA at the recommended time, avoided alcohol consumption and smoking during pregnancy. In all, 35.3% of mothers reported to consuming alcohol, 20.9% smoked during pregnancy and 44.4% commenced FA at the recommended time. Mothers <25 years were more likely to have not taken FA at the recommended time (adjusted odds ratio (aOR): 4.0, 95% confidence interval (CI): 1.64–9.77) and were more likely to have smoked during pregnancy (aOR: 3.56, 95% CI: 1.32–9.57). Irish nationality positively predicted both alcohol consumption (aOR: 4.37, 95% CI: 1.88–10.15) and smoking (aOR: 10.92, 95% CI: 1.35–87.98) during pregnancy.Conclusions:Educational efforts are still necessary to convince women of Irish nationality, in particular, of the adverse effects of smoking and alcohol consumption on fetal outcome. Women <25 years should be specifically targeted in smoking cessation and FA promotional campaigns.

Assessment of Obesity and Fear of Fatness Among Inner-City Dublin Schoolchildren in a One-Year-Follow-Up Study

BACKGROUND Positive secular trends in adolescent obesity and an increased prevalence of fear of fatness, particularly among girls, have been documented world-wide. There is a lack of consensus about assessment criteria for childhood obesity and no standard exists for assessing Irish children. In 1990, the Irish National Nutrition Survey used body mass index (BMI) > or =26 kg m(-2) to describe the prevalence of overweight among Irish adolescents. OBJECTIVES (1) To examine the range in classification of Dublin schoolchildren as overweight according to four standard assessment methods; (2) to assess changes in weight status, prevalence of fear of fatness and accompanying slimming practices in a one-year follow-up; and (3) to compare the prevalence of overweight with that documented in 1990 among adolescents of similar age. DESIGN A one-year follow-up study of 199 healthy schoolchildren (90 boys and 109 girls; mean age of 11 years at baseline) attending seven fee-paying (six single- and one mixed-sex) and eight non-fee-paying (four single- and four mixed-sex) primary schools in Dublin city centre. MEASUREMENTS Weight, height, waist circumference and triceps skinfold were measured and used in five definitions of overweight, including published cut-off points of BMI-for-age (Centers for Disease Control and Prevention BMI-for-age charts for boys and girls; BMI reference curves for the UK 1990; International Obesity Task Force age- and sex-specific BMI cut-offs), actual relative weight and BM > or =26 kg m(-2). Assessment of body image perceptions and satisfaction (using figure line drawings) was reported in a questionnaire specifically designed for this study. RESULTS The prevalence of overweight within the total group differed between the four standard definitions of weight status, by 9% at baseline and 8% at follow-up. Accordingly, increasing trends over the year ranged from zero to 3%. Using the criterion BMI > or =26 kg m(-2), 6% of Dublin schoolchildren were overweight, compared with 1.9% of schoolchildren in 1990. Significantly more girls than boys were affected by fear of fatness and were trying to lose weight. CONCLUSION A standard method for assessment of weight status is urgently needed for the evaluation of obesity prevention initiatives among Irish schoolchildren. Such initiatives need to be sensitive to the pervasiveness of fear of fatness among adolescent girls.

Maternal and infant nutritional supplementation practices in Ireland: implications for clinicians and policymakers.

This prospective Irish observational study examined maternal and infant nutritional supplement use. From an initial sample of 539 mothers recruited from the Coombe Women and Infants University Hospital in Dublin (during 2004-2006), 450 eligible mothers were followed up at 6 weeks and 6 months postpartum. Only 200 women (44.4%) complied with peri-conceptional folic acid at the recommended time with strong social patterning associated with its uptake. Almost 10% of the sample (n = 44) consumed a combined multivitamin and mineral supplement during pregnancy. A vitamin D-containing supplement was provided to only 5 (1.1%) and 15 (3.3%) infants at 6 weeks and 6 months, respectively. A national guideline that advises on adequate and safe use of both vitamin and multivitamin supplements during pregnancy with particular reference to vitamin A and D is warranted. Given the re-emergence of rickets in Ireland, and the reported morbidities associated with vitamin D insufficiency, promoting and monitoring compliance with 200 IU [5 microg] daily vitamin D supplements to all infants particularly those from higher risk groups from birth to 1 year, should be a public health priority.

Weaning Onto Solid foods: Some of the Challenges

Weaning--the transition from milk to solid food--influences life-long health. Dietary challenges during weaning include providing sufficient critical nutrients such as iron with minimal added sugar and fat and no added salt. This study assessed the inclusion of iron-containing red meat in infant diets before age one year, and the Irish commercial baby food environment. Of mothers with an infant under 30 months of age who were surveyed in shopping centres in Ireland (n195), 82% (n159) reported wanting more weaning information. A quarter (n24) of infants over age 12 months (n97) received no iron-containing red meat before age one year. A scan of commercial baby foods in Ireland identified 448 products. While all complied with baby food legislation, 15% (n69) were intrinsically high in sugar and fat, or contained added salt. This study indicates the need for specific guidance on best infant feeding practice in Ireland.

Weaning onto solid foods in Ireland: some of the challenges

A supportive environment is a key determinant of healthy behaviours, including best infant feeding practice. Weaning, defined as the transition from milk to solid foods during the first year of life, is a critical phase during which a variety of staples from the main food groups are introduced. In particular, introducing dietary sources of haem Fe from 6 months of age is essential to avoid the adverse effects of Fe deficiency. Foods rich in added fat, sugar or salt should be avoided. A previous study of Dublin-based infants found that inappropriate weaning practices were relatively common at 6 months of age (1) . The present study examined the presence of haem Fecontaining foods in infant diets before 1 year of age and the commercial baby food environment in Ireland. Mothers with an infant less than 30 months of age were surveyed in shopping centres in Ireland. A standardised questionnaire obtained information on: the inclusion of recommended red meats beef, pork and lamb; mothers’ knowledge of weaning and the importance of Fe, and; their use of commercial baby foods. A scan of commercial baby foods available in Ireland was conducted, and all products identified were assessed under European Union Commission Directive 2006/125/EC. Of the total group (n 195), 82 % (n 159) of mothers reported wanting more information on weaning, and almost a third (29 %, n 57) named the public health nurse as the most useful source of information on weaning. A quarter (n 24) of infants aged over 12 months (n 97) did not receive any of the recommended red meats before one year of age. Over two-thirds of mothers (69 %, n 135) were unaware of the age at which Fe is important in an infant’s diet. Mothers aware of the correct age reported introducing red meats significantly earlier (7.11.5 months v. 8.42.5 months, P = 0.006). More than two-thirds (68 %, n 113) of mothers said they used commercial baby foods. All commercial baby foods identified in the scan (n = 448) complied with relevant legislation. However, 15 % of products (n 69) did not emulate best practice in infant feeding. This may be a concern as 33 % (n 62) of mothers reported using types of commercial baby foods available to give them ideas for homemade meals.

Maternal awareness of the association between paediatric diet and adult disease risk: A follow-up to the DIT–Coombe Hospital Study

Chronic disease has been traditionally attributed to risk factors in adulthood; however, current orthodoxy suggests that the true origins of such diseases are initiated much earlier in life from inappropriate nutritional circumstances arising during the formative years. The present study was undertaken to examine current maternal attitudes towards the importance of paediatric diet in relation to adult diseases and to determine the extent to which attitudinal differences between subgroups in the population exist. A non-randomised postal follow-up survey to the DIT–Coombe Hospital Infant Feeding Study was carried out, involving the recruitment of 209 mothers from a pool sample of 520 mothers in the previous study (response rate 46.7%). Quantitative data were obtained from a cross-sectional questionnaire ranking maternal attitudes towards infant diet on a five-point Likert scale (from strongly disagree to strongly agree) of perceived importance. In general, a higher percentage of respondents (64) had a cumulative positive view of the relationship between paediatric diet and disease risk. Of the mothers >70% expressed a strong positive attitude towards the influence of early childhood diet and the risk of being overweight, poor growth and development, unhealthy food preference, osteoporosis, diabetes, high blood pressure and heart disease. In comparison, cancer, eczema and food allergies were viewed positively overall but the extent to which individuals most strongly agreed with each fell to <50%. The majority had a negative opinion (either disagreed strongly or tended to disagree) of the importance of paediatric diet in mental health problems. According to one-way ANOVA analysis, attitudinal differences in mean scores (P<0.05) were observed in mothers according to age at time of birth, education level, accommodation status and health insurance status, as well as the timing of weaning (Table).

Early formula feeding practices and their potential contribution to later obesity risk

Background and Aims Early feeding practices, including early introduction to solid foods and overfeeding, are known risk factors for childhood obesity. This study aimed to assess maternal formula feeding practices and infant formula feeding patterns, factors that are known to potentially contribute to later obesity risk. Methods This Irish prospective observational study involved the recruitment and follow-up of 450 eligible mother-infant pairs to 6 weeks postpartum. Data related to formula milk consumption patterns, formula type/brand changing, additions of solids to bottle feeds were examined, and available infant 6 week weight measurements recorded. Results In total, 368 (81.8%) mothers provided any formula milk to their infants at 6 weeks; of these, 14 (3.8%) reported to adding solid foods to their infant’s bottle feeds. Almost 50% of formula feeding mothers (n = 181) reported to changing their infant’s formula type/brand at least once during the first 6 weeks, mainly due to increased hunger and feeding frequency (2–3 hourly) (54.8%). Where 6 week infant weight measurements were available (n = 184), a mean of 205ml (SD 45ml) of formula milk/kilogram body weight/day was consumed by these infants. Conclusion Several formula feeding practices with potential implications for later obesity risk were identified in this study including premature introduction to solids (≤ 6 weeks) and consumption of excessive formula milk volumes at 6 weeks relative to infant feeding guidelines. Early provision of recommended feeding guidelines including specific advice on age-appropriate milk volumes to parents who formula feed should be considered in obesity prevention programmes.

Are mothers aware of the importance of infant feeding and paediatric nutrition? A follow-up to the DIT-Coombe Hospital Study

Paediatric nutrition, fundamentally influenced by maternal feeding attitudes and behaviours, plays a pivotal role in influencing an individual’s health from conception throughout childhood and later during adult life. However, current feeding practices do not always concur with the optimal infant feeding recommendations. The present project thus seeks to acquire an insight into the maternal infantfeeding attitudes and to identify whether these attitudes differ socio-demographically between subgroups in the population, in order to correctly target and proactively educate mothers in most need of intervention. A non-randomised postal follow-up survey to the DIT-Coombe Hospital Infant Feeding Study was conducted, involving the recruitment of 209 mothers from a pool sample of 520 mothers in a previous study (participant rate 40.2%, response rate 46.7%). Quantitative data were obtained from a cross-sectional questionnaire ranking maternal attitudes towards diet and infant feeding practices on a Likert scale of perceived importance.