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Nutrition And Public Health > Infant Feeding And Disease Risk > Flashcards

Infant Feeding And Disease Risk Flashcards

1
Q

Methodology for infant feeding recommendations (observational studies, RCTs, follow up studies) and PROS and CONS

A
  • observational: large sample sizes, disease end points available. But not randomised so cannot conclude causality, also different definitions of EBF, issues of reverse causality (alternation of behaviour due to disease outcome)
  • RCTs: gold standard for causality. But unethical to randomise, expensive, and difficult to standardise due to different compositions of milk
  • follow up studies: issues with selection bias, loss of power, high attrition rates
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2
Q

Experimental study for breastfeeding: RCT with donor BM vs formula

A
  • donor breastmilk versus formula for 1 month
  • preterm babies
  • breastmilk showed better blood lipids, better BP in adolescence, reduced NEC, tolerated EN better, lower requirements for PN
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3
Q

Experimental study: PROHIBIT breastfeeding promotion study

A
  • breastfeeding promotion
  • 1 year: lower GI infections, atopic dermatitis
  • 6 years: higher IQ, but no effect on BP or anthropometry
  • at 11.5 years: no effect on adiposity, obesity, fat mass
  • at 16 years: obesity was greater in the BF arm
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4
Q

Key findings of the LANCET report on BF: impact on baby, mother, infection, obesity

A
  • impact on baby: improved malocclusion, intelligence, reduction in overweight and diabetes, no difference in allergies/asthma/BP/cholesterol
  • impact on women: reduces breast cancer, T2DM, ovarian cancer, improved birth spacing
  • in LMIC babies had reduced diarrhoea and respiratory infection
  • demonstrates a 26% protection against obesity
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5
Q

Nutritional and non-nutritional reasons children need complementary feeding

A
  • nutritional: need additional nutrients not present in high amounts in breastmilk (i.e Fe)
  • non-nutritional: cultural preferences, behavioural, induction of tolerance and taste preferences
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6
Q

Potential issues with introduction of complementary foods

A
  • risk nutritional deficits
  • hygiene
  • food availability
  • allergy
  • risk of infection
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7
Q

Aspects to consider: timing of complementary foods

A
  • developmental readiness: do they have adequate neuromuscular development for a safe swallow?
  • GI and renal development: can they handle radical nutritional changes?
  • social and cultural factors
  • maternal preference
  • nutritional adequacy: how long can breastmilk meet requirements for? Some studies suggest just need additional vit D and K supplements, others suggest that Fe deficiency may occur with prolonged breastfeeding
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8
Q

Expert opinions on EBF: WHO

A
  • WHO recommend exclusive breastfeeding for 6 months with feeding continuing for 1 year
  • based on an SLR
  • mother: increased weight loss and reduced menses
  • baby: no impact on infant mortality or growth, but may lower infant morbidity (diarrhoea and GI infection) but not in all countries
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9
Q

Expert opinions on EBF: EFSA NDA panel

A
  • commissioned a literature review
  • did not include key health benefits of EBF, the effects of different textures and varieties of food
  • concluded that current evidence doesnt give a specific age for more appropriate CF
  • but, provided food was of appropriate texture and was nutritionally complete then there were no adverse outcomes associated with introduction of complementary foods
  • skills for finger foods can be seen at 4 months
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10
Q

Expert opinions on EBF: USDA

A
  • CF at 4 months doesnt lead to any measurable negative outcomes versus 6 months
  • early introduction of CF at 4 months doesnt improve Fe status
  • early introduction of allergens doesnt increase allergy risk
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11
Q

Conclusions on introduction of allergy foods

A
  • general agreement that there is no need to delay introduction
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12
Q

‘At risk’ nutrients with prolonged breastfeeding

A
  • Fe, vitamin D, iodine, ALA, DHA
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13
Q

What are the concerns with complementary feeding for LMIC versus HIC?

A
  • HIC: too high energy density

- LMIC: provision of sufficient nutrients

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14
Q

At 12 months, what is the proportion of food infants are eating and what is the size of their stomach?

A
  • eating 12% of their body weight everyday

- 200 mL capacity stomach

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15
Q

Complementary feeding and fat

A
  • do not restrict- need to have high kcal density
  • no link between fat intake and later adiposity
  • need to avoid trans fats and focus on fats with essential nutrients: soybean and rapeseed oil
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16
Q

Complementary feeding and protein

A
  • should keep to <15% of kcal intake
  • avoid cows milk for first year of life (too high in protein and poor Fe source)
  • in LMIC need to focus on good biological sources of Fe such as eggs, fish
  • biological sources of protein has lower levels of anti-nutrients
17
Q

Complementary feeding and carbohydrates

A
  • dont want too high fibre or sugar
  • no nutritional requirements for free sugars and may impact glycaemia and obesity risk
  • lactose and fructose from fruits are completely fine
18
Q

Iron and zinc and complementary feeding

A
  • requirements are very high in first 5 months of life
  • Fe: 9x adult male, Zn 4x adult male
  • inadequate intake leads to stunting, infection and anaemia
  • high bioavailability in red meats and fortified cereals
19
Q

Baby led weaning

A
  • not enough evidence that they are getting enough food for Fe stores, and denote and increased choking risk
  • papers have found that it doesnt lead to reduced risk of overweight or healthier growth
  • but can lead to greater enjoyment of food and reduced food fussiness
  • instead, use responsive feeding: responding to infant hunger and satiety cues, not all crying is due to hunger, do not use food as comfort or reward
20
Q

WHO feeding principles

A
  • EBF at 6 months and continue for 1 year
  • CF at 6-8.9 months
  • minimum dietary diversity at 6-23.9 months. Foods from >4 food groups in last 24 hours (dairy, legumes/nuts, fruit/veg, vit A fruit/veg, eggs, flesh foods, grains/roots/tubers)
  • minimum meal frequency is at least 2 per day up to 8.9 months, >8.9 months is at least 3 per day
  • Fe rich or Fe fortified foods
21
Q

Important considerations for HIC, LIC and both

A
  • HIC: EBF for at least 4 months, protein <15% intake, avoid excessive cows milk
  • LIC: EBF for at least 6 months, energy and nutrient dense foods, high quality protein sources (animal)
  • both: no added sugars, good sources of Fe and Zn, allergenic foods treated like other CF, responsive feeding

Nutrition And Public Health (20 decks)

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