Martina A. Schmid

Influences on infant feeding decisions of first-time mothers in five European countries

BACKGROUND/OBJECTIVES:Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours.SUBJECTS/METHODS:First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007–2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests.RESULTS:In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts.CONCLUSION:Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

Lifetime health outcomes of breast-feeding: a comparison of the policy documents of five European countries

OBJECTIVE To (i) identify and describe prevailing infant feeding policy documents in five diverse European countries; (ii) analyse types of health outcomes for the infant that are associated with feeding breast milk rather than formula milk in the documents of different countries; and (iii) assess the extent to which documents reflect the WHO global recommendation of exclusive breast-feeding for 6 months. DESIGN Documentary review and analysis. SETTING Five geographically dispersed countries of Europe (England, Finland, Germany, Hungary and Spain). SUBJECTS Policy documents on infant feeding were identified; statements that linked choice between breast- and formula-feeding to a health outcome for the infant were extracted. RESULTS Twenty-six documents (varied authorships, dates, length and character) were identified: four from England; two from Finland; nine from Germany; six from Hungary; and five from Spain. There was no consistency in the way in which health outcomes were cited as factors in the recommendations for breast- rather than formula-feeding. Seven documents contained no reference to the health implications of infant feeding choice. Of 203 statements in remaining documents citing health outcomes, 24.1 % mentioned general health effects, 32.5 % protection against infections, 31.5 % long-term conditions (e.g. diabetes, CVD) and 11.8 % mentioned allergy. Health outcomes were linked to exclusive breast-feeding in only 25 % of statements. CONCLUSIONS Policy documents in the study countries varied in the extent to which they reflect the health outcomes for the baby of breast-feeding, and this may limit effective promotion by health professionals. There is scope to improve the process of bringing evidence and recommendations into policy documents.

Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries

Parents’ decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.

Developmental origins of health and disease: the views of first-time mothers in 5 European countries on the importance of nutritional influences in the first year of life

BACKGROUND The programming concept suggests that poor early nutrition causes an array of medical problems later in life. Public health messages about the implications of programming may not be reaching parents and influencing infant feeding behaviors. OBJECTIVE The views of new mothers were sought about the extent to which lifelong health is influenced by diet as an infant, rather than by genetic predispositions or lifestyles and behaviors. DESIGN A questionnaire survey of first-time mothers was undertaken in 5 European countries. RESULTS A convenience sample of 2071 mothers from England (438), Finland (426), Germany (414), Hungary (389), and Spain (404) self-completed the questionnaire. High proportions of mothers agreed that how an infant is fed affects his or her health over the first year (95.8%) and in subsequent years (88.5%), but the effect of infant feeding decisions on the development of long-term conditions was the least-cited underlying reason. Diet as an infant was rated an extremely/very important influence on adult health by 64% of mothers, equivalent to environmental pollution (63%), but by fewer mothers than were diet and physical activity in childhood/adolescence (79%, 84%) and adulthood (81%, 83%), genetics/inheritance (70%), and exposure to cigarette smoke (81%). Inter- and intracountry differences were observed. CONCLUSIONS Mothers in this study consider diet as an infant to be a less important influence on lifelong health than many lifestyle, behavioral, and environmental factors and genetics. Further dissemination of the implications of programming to consumers may be warranted.

[13C]Methionine Breath Test as a Marker for Hepatic Mitochondrial Function in HIV-Infected Patients

Metabolic disturbances such as dyslipidemia, lipodystrophy syndrome, visceral obesity, hyperlactatemia, diabetes mellitus, and hepatic steatosis have been recognized as serious complications in long-term antiretroviral-treated HIV-infected patients. The oxidative capacity of liver mitochondria plays a central role in their pathogenesis and can be analyzed using the [(13)C]methionine breath test. We analyzed hepatic mitochondrial function using the [(13)C]methionine breath test in antiretrovirally treated and untreated HIV-infected patients as well as HIV-negative controls. Patients with hepatic steatosis, hypertriglyceridemia, lipohypertrophy, and older age showed reduced methionine metabolism. Hepatic mitochondrial function is impaired in antiretroviral-treated HIV-infected patients with disturbances of lipid metabolism.

Obesity Related Programming Statements in Materials on Infant Feeding Aimed at Parents in Five European Countries

Early nutrition programming as an origin of obesity is well acknowledged, but to what extent is this concept communicated to parents? In five European countries, UK, Finland (FI), Germany (DE), Hungary (HU) and Spain (ES), a total of 130 stand alone leaflets and 161 articles from parenting magazines providing information on feeding of healthy infants aged 0-12 months were identified and screened for nutrition programming statements. Obesity was mentioned in 8.5% (54/638) of the statements, and was the fourth most frequent outcome after allergy (20.7%), risk of infections (15.5%) and growth and development (11.4%). A temporal prognosis was given in 39% of obesity related statements, 6% referring to short- (< 5 years), 13% to medium- (5-15 years) and 20% to long-term (>15 years) duration of effects. So advice on obesity focuses on the intrinsic long-term perspective of programming in contrary to other surveyed health-outcomes where only 8- considered a lifelong approach. The major programming related behaviour concerned breast-feeding compared to formula and complementary feeding with meaningful differences concerning the recommended duration: for ES and HU the predominant advice was for exclusive breast-feeding for 6 months, for DE exclusive breast-feeding for 4-6 months and for UK and FI breast-feeding without further specification. In summary, statements relating to the programming of later obesity have been partially integrated into feeding information in five European countries. These countries have slightly different breastfeeding recommendations, but consistently refer to the preventive potential of breastfeeding in general. This is important as obesity and its resulting morbidity are of increasing public health concern in developed countries.

Infant Feeding and the Concept of Early Nutrition Programming: A Comparison of Qualitative Data from Four European Countries

The concept of early nutrition programming is appearing in policy documents, leaflets and magazine articles with different types of statements. However, the level of representation and influence of this concept is unknown in the area of infant nutrition. We established the degree of reflection and the impact of the concept of nutrition programming among the different government stakeholders of infant nutrition in four European countries. In each country, a list of stakeholders in the area of infant feeding was established and key persons responsible for the remit of infant nutrition were identified. We conducted standardised face-to-face or phone interviews from January 2006 to January 2007. The interview guide included questions about the concept of nutrition programming. All interviews were digitally recorded and qualitative data analysis was done using QRS NVivo V2. In total, we analyzed 17 interviews from government organizations in England (5 interviews), Germany (4 interviews), Hungary (3 interviews) and Spain (5 interviews). The concept of nutrition programming was recognized from 4/5 English and 3/4 German interviewees, whereby one organisation reflected the concept in their documents in both countries. In Hungary, 1/3 interviewees recognised the concept and reflected it in their documents. All interviewed Spanish governmental bodies (5/5) recognised the concept of nutrition programming and three of them reflected the concept in their documents. The concept of early nutrition programming was widely recognized among the key persons of government bodies in all four European countries. However, the concept was not necessarily represented in the produced documents.

Obesity Related Programming Statements in Infant Feeding Policies in Five European Countries

The aim of this study was to know how the early nutrition programming concept and its relation with long-term diseases such as obesity is reflected in policy recommendations on infant nutrition in five European countries (Finland, Germany, Hungary, Spain and England). After collating and evaluating infant nutrition policy documents, statements about early nutrition programming, as the origin of diseases such as obesity, were analysed. The number of policy documents analysed were 38 (England: 10, Finland: 2, Germany: 11, Hungary: 8, Spain: 7) with a total of 455 statements identified and categorized into 53 different health outcomes. Obesity was mentioned in 5.5% (n = 25) of the statements, the third most frequent outcome after allergy (14.1%, n = 64) and health in general (5.7%, n = 26). Twenty six percent (n = 6) of the obesity related statements referred to short-term duration of the effects, 48% (n = 12) to medium-term, 24% (n = 6) to long-term effects and the rest were not identified. Only 22% of the obesity statements were evidence based. The link between infant feeding and obesity is integrated into policy documents, but most of the statements did not fully specify the short, medium and long term health implications. Action may be required to keep documents up to date as new evidence emerges and to ensure the evidence base is properly recorded.

Infant feeding intentions of new mothers in five European countries

H. Gage, J. Morgan, P. Williams, M. Schmid, K. Laitenen, J. von Rosen, B. Koletzko, T. Decsi, V. Jacobi, E. Martin-Bautista, C. Campoy and M. M. Raats Food, Consumer Behaviour and Health Research Group, University of Surrey, Guildford GU2 7XH, UK, Department of Biochemistry and Food Chemistry, University of Turku, Turku, Finland, Dr von Hauner Children’s Hospital, Munich, Germany, Department of Pediatrics, University of Pecs, Pecs, Hungary and Department of Pediatrics, University of Granada, Granada, Spain

Programming effect of breast-feeding in infant nutrition policy documents in Hungary

AIMS To identify and describe infant feeding policy documents in Hungary and compare them to the documents of other four European countries (England, Finland, Germany and Spain). The question was also addressed how the phenomenon of nutritional programming was represented in the documents. SUBJECTS Policy documents on infant feeding were identified and analyzed in the five European countries by using uniform methods for searching and coding. RESULTS Twenty-six documents were identified: 4 in England, 2 in Finland, 9 in Germany, 6 in Hungary and 5 in Spain. Altogether 203 statements linked to references were identified: benefits of breast-feeding in general (24%), protection against infections (32%), long-term advantages like the prevention of diabetes (31%) or allergy (12%). Considerable variations were found within and between countries in the evaluation of the duration and character of the positive effects. The majority of the statements in the Hungarian documents referred either to the role of breast-feeding in infection protection (n = 8), or to long-term protective effects (n = 13). CONCLUSION Policy documents in the study countries varied both in their extent and in the description of the long-term effects of infant nutrition. Majority of the documents failed to contain evidence based discussion of the phenomenon of early nutritional programming.Cel: A csecsemőtaplalassal foglalkozo iranyelvek osszegyűjtese Magyarorszagon es osszehasonlitasuk masik negy europai orszag (Anglia, Finnorszag, Nemetorszag es Spanyolorszag) hasonlo dokumentumaival. A szerzők arra a kerdesre kerestek a valaszt, hogy milyen modon jelenik meg a taplalasi programozodas jelensege a dokumentumokban. Modszer: Egy erre a celra kidolgozott egyseges keresesi es kodolasi rendszer segitsegevel a szerzők megkerestek es elemeztek a csecsemőtaplalassal foglalkozo dokumentumokat a vizsgalt ot europai orszagban. A kereses osszesen 26 dokumentumot eredmenyezett: Angliaban negyet, Finnorszagban kettőt, Nemetorszagban kilencet, Magyarorszagon hatot es Spanyolorszagban otot. A dokumentumokban 203 olyan megallapitast talaltak, amelynek idezhető hivatkozasa volt. A megallapitasok a szoptatas előnyeire (24%), a fertőzesek elleni vedő szerepere (32%) es olyan hosszu tavu hatasaira, mint a diabetes (31%) es az allergia (12%) megelőzese vonatkoztak. A magyar dokumentumokban a legtobb megallapitas az anyatejes taplalas fertőzesekkel szembeni vedő szerepere (n = 8), valamint a hosszu tavu vedőhatasokra (n = 13) vonatkozott. Az egyes orszagok kozott jelentős kulonbsegeket talaltak a pozitiv hatas tartamanak es jellegenek megiteleseben. Kovetkeztetes: A csecsemőtaplalassal foglalkozo nemzeti dokumentumok az osszehasonlitott ot europai orszagban jelentősen eltertek terjedelmukben es a csecsemőtaplalas hosszu tavu hatasainak leirasaban egyarant. A dokumentumok tobbsegeből hianyzott a korai taplalasi programozodas jelensegenek a bizonyitekokon alapulo orvoslas elveinek megfelelő targyalasa. Orv. Hetil., 2011, 152, 1641–1647. | Aims: To identify and describe infant feeding policy documents in Hungary and compare them to the documents of other four European countries (England, Finland, Germany and Spain). The question was also addressed how the phenomenon of nutritional programming was represented in the documents. Subjects: Policy documents on infant feeding were identified and analyzed in the five European countries by using uniform methods for searching and coding. Results: Twenty-six documents were identified: 4 in England, 2 in Finland, 9 in Germany, 6 in Hungary and 5 in Spain. Altogether 203 statements linked to references were identified: benefits of breast-feeding in general (24%), protection against infections (32%), long-term advantages like the prevention of diabetes (31%) or allergy (12%). Considerable variations were found within and between countries in the evaluation of the duration and character of the positive effects. The majority of the statements in the Hungarian documents referred either to the role of breast-feeding in infection protection (n = 8), or to long-term protective effects (n = 13). Conclusion: Policy documents in the study countries varied both in their extent and in the description of the long-term effects of infant nutrition. Majority of the documents failed to contain evidence based discussion of the phenomenon of early nutritional programming. Orv. Hetil., 2011, 152, 1641–1647.Cel: A csecsemőtaplalassal foglalkozo iranyelvek osszegyűjtese Magyarorszagon es osszehasonlitasuk masik negy europai orszag (Anglia, Finnorszag, Nemetorszag es Spanyolorszag) hasonlo dokumentumaival. A szerzők arra a kerdesre kerestek a valaszt, hogy milyen modon jelenik meg a taplalasi programozodas jelensege a dokumentumokban. Modszer: Egy erre a celra kidolgozott egyseges keresesi es kodolasi rendszer segitsegevel a szerzők megkerestek es elemeztek a csecsemőtaplalassal foglalkozo dokumentumokat a vizsgalt ot europai orszagban. A kereses osszesen 26 dokumentumot eredmenyezett: Angliaban negyet, Finnorszagban kettőt, Nemetorszagban kilencet, Magyarorszagon hatot es Spanyolorszagban otot. A dokumentumokban 203 olyan megallapitast talaltak, amelynek idezhető hivatkozasa volt. A megallapitasok a szoptatas előnyeire (24%), a fertőzesek elleni vedő szerepere (32%) es olyan hosszu tavu hatasaira, mint a diabetes (31%) es az allergia (12%) megelőzese vonatkoztak. A magyar dokumentumokban a legtobb megallapita...