The complementary feeding period (6-23 months of age) is when solid foods are introduced alongside breastmilk or infant formula and is the most significant dietary change a person will experience. The introduction of complementary foods is important to meet changing nutritional requirements(1). Despite the rising Asian population in New Zealand, and the importance of nutrition during the complementary feeding period, there is currently no research on Asian New Zealand (NZ) infants’ micronutrient intakes from complementary foods. Complementary foods are a more easily modifiable component of the diet than breastmilk or other infant milk intake. This study aimed to compare the dietary intake of micronutrients from complementary foods of Asian infants and non-Asian infants in NZ. This study reported a secondary analysis of the First Foods New Zealand cross-sectional study of infants (aged 7.0-9.9 months) in Dunedin and Auckland. 24-hour recall data were analysed using FoodFiles 10 software with the NZ food composition database FOODfiles 2018, and additional data for commercial complementary foods(2). The multiple source method was used to estimate usual dietary intake. Ethnicity was collected from the main questionnaire of the study, answered by the respondents (the infant’s parent/caregiver). Within the Asian NZ group, three Asian subgroups were identified – South East Asian, East Asian, and South Asian. The non-Asian group included all remaining participants of non-Asian ethnicities. Most nutrient reference values (NRV’s)(3) available for the 7-12 month age group are for total intake from complementary foods and infant milks, so the adequacy for the micronutrient intakes from complementary foods alone could not be determined. Vitamin A was the only micronutrient investigated in this analysis that had an NRV available from complementary foods only, allowing conclusions around adequacy to be made. The Asian NZ group (n = 99) had lower mean group intakes than the non-Asian group (n = 526) for vitamin A (274µg vs. 329µg), and vitamin B12 (0.49µg vs. 0.65µg), and similar intakes for vitamin C (27.8mg vs. 28.5mg), and zinc (1.7mg vs. 1.9mg). Mean group iron intakes were the same for both groups (3.0mg). The AI for vitamin A from complementary foods (244µg) was exceeded by the mean intakes for both groups, suggesting that Vitamin A intakes were adequate. The complementary feeding period is a critical time for obtaining nutrients essential for development and growth. The results from this study indicate that Asian NZ infants have lower intakes of two of the micronutrients of interest than the non-Asian infants in NZ. However, future research is needed with the inclusion of infant milk intake in these groups to understand the total intake of the micronutrients. Vitamin A intakes do appear to be adequate in NZ infants.

Relatively little is known about how the diet of chronically undernourished children may impact cardiometabolic biomarkers. The objective of this exploratory study was to characterise relationships between dietary patterns and the cardiometabolic profile of 153 3–5-year-old Peruvian children with a high prevalence of chronic undernutrition. We collected monthly dietary recalls from children when they were 9–24 months old. At 3–5 years, additional dietary recalls were collected, and blood pressure, height, weight, subscapular skinfolds and fasting plasma glucose, insulin and lipid profiles were assessed. Nutrient intakes were expressed as average density per 100 kcals (i) from 9 to 24 months and (ii) at follow-up. The treelet transform and sparse reduced rank regress'ion (RRR) were used to summarize nutrient intake data. Linear regression models were then used to compare these factors to cardiometabolic outcomes and anthropometry. Linear regression models adjusting for subscapular skinfold-for-age Z-scores (SSFZ) were then used to test whether observed relationships were mediated by body composition. 26 % of children were stunted at 3–5 years old. Both treelet transform and sparse RRR-derived child dietary factors are related to protein intake and associated with total cholesterol and SSFZ. Associations between dietary factors and insulin were attenuated after adjusting for SSFZ, suggesting that body composition mediated these relationships. Dietary factors in early childhood, influenced by protein intake, are associated with cholesterol profiles, fasting glucose and body fat in a chronically undernourished population.

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19–2·90), whose mothers were < 30 years old (1·69; 1·46–1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1–1·70), of Māori v. European ethnicity (1·40; 1·12–1·75) or smoked during pregnancy (1·88; 1·44–2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27–0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16–3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24–4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

Anaemia affects approximately 69 % of Indian children aged 6–12 months, with Fe deficiency (ID) being a common cause. The effectiveness of micronutrient-fortified infant cereal in improving Fe status and neurodevelopment was evaluated in non-anaemic and mildly anaemic Indian infants. An intervention group (IC) enrolled at age 6 months consumed 50 g/d of rice-based cereal providing 3·75 mg Fe/d as ferrous fumarate for 6 months (n 80) and was compared with a matched static cross-sectional control group (CG) without intervention enrolled at age 12 months (n 80). Mean Hb was higher in IC (118·1 (sd 10·2) g/l) v. CG (109·5 (sd 16·4) g/l) at age 12 months (adjusted mean difference: 9·7 g/l; 95 % CI 5·1, 14·3; P < 0·001), while geometric mean serum ferritin tended to be higher (27·0 (–1 sd 13·4, +1 sd 54·4) v. 20·3 (–1 sd 7·5, +1 sd 55·0) ng/ml); P = 0·085) and soluble transferrin receptor was lower (1·70 (–1 sd 1·19, +1 sd 2·43) v. 2·07 (–1 sd 1·29, +1 sd 3·33) mg/l; P = 0·014). Anaemia (23 v. 45 %; P = 0·007) and ID (17 v. 40 %; P = 0·003) were lower in IC v. CG. Bayley Scales of Infant and Toddler Development Third Edition scores for language (P = 0·003), motor development (P = 0·018), social-emotional (P = 0·004) and adaptive behaviour (P < 0·001), but not cognitive development (P = 0·980), were higher in IC v. CG. No significant difference in anthropometric Z-scores was observed between the groups. Consuming a micronutrient-fortified infant cereal daily for 6 months during complementary feeding promoted better Fe status while reducing the risk for anaemia and ID and was associated with superior neurodevelopmental scores.

We aimed to comprehensively examine the association of breast-feeding, types and initial timing of complementary foods with adolescent cognitive development in low- and middle-income countries. We conducted a prospective cohort study of 745 adolescents aged 10–12 years who were born to women who participated in a randomised trial of prenatal micronutrient supplementation in rural Western China. An infant feeding index was constructed based on the current WHO recommendations. Full-scale intelligence quotient (FSIQ) was assessed and derived by the fourth edition of the Wechsler Intelligence Scale for Children. The duration of exclusive or any breast-feeding was not significantly associated with adolescent cognitive development. Participants who regularly consumed Fe-rich or Fe-fortified foods during 6–23 months of age had higher FSIQ than those who did not (adjusted mean differences 4·25; 95 % CI 1·99, 6·51). For cows’/goats’ milk and high protein-based food, the highest FSIQ was found in participants who initially consumed at 10–12 and 7–9 months, respectively. A strong dose–response relationship of the composite infant feeding index was also identified, with participants in the highest tertile of overall feeding quality having 3·03 (95 % CI 1·37, 4·70) points higher FSIQ than those in the lowest tertile. These findings suggest that appropriate infant feeding practices (breast-feeding plus timely introduction of appropriate complementary foods) were associated with significantly improved early adolescent cognitive development scores in rural China. In addition, improvement in Fe-rich or Fe-fortified foods complementary feeding may produce better adolescent cognitive development outcomes.

Over the past two decades, increasing efforts have been made to find suitable nutritional products for managing particularly moderate forms of malnutrition following acute phase treatment, including the adoption of ready-to-use therapeutic foods. The challenge in meeting nutrient needs of normal growing young children and other vulnerable population groups with scant food supply has led us to explore the use of local, traditional and culturally adaptable food-based complementary foods employing the food multimix (FMM) concept. The present paper examined FMM as a concept to demonstrate how locally available composite complementary recipes were used to create highly nutritious recipes at low cost and improve nutrition among vulnerable individuals. The method employed a food-to-food fortification approach for recipe development making use of the ‘nutrient strengths’ of candidate ingredients. A range of different food recipes had been developed using a stepwise approach and combinations of foods from different populations and communities and packaged as 100 g recipe powders. Proximate and micronutrient analyses have been undertaken, optimised and the nutrient compositions compared with reference nutrient intakes for target groups. Examples of recipes and their nutrient profiles had been highlighted for different formulations showing different ingredients. Theoretical nutrient values were translated into practice based on data from intervention studies. The FMM approach using locally available food has held promise, and published evidence did indicate that the concept can contribute significantly to long-term food-based solutions to meeting nutrient needs of vulnerable groups in poor communities.

Exclusive breast-feeding (EBF) for 6 months supports optimal infant growth, health and development. This paper examined whether maternal HIV status was associated with EBF and other infant feeding practices. Pregnant women were enrolled after HIV counselling, and their babies were followed up for up to 1 year. Data on household socio-economics and demographics, maternal characteristics and infants’ daily diet were available for 482 infants and their mothers (150 HIV-positive (HIV-P), 170 HIV-negative (HIV-N) and 162 HIV-unknown (HIV-U)). Survival analyses estimated median EBF duration and time to introduction of liquids and foods; hazards ratios (HR) used data from 1–365 and 1–183 d, adjusting for covariates. Logistic regression estimated the probability of EBF for 6 months. Being HIV-P was associated with a shorter EBF duration (139 d) compared with HIV-N (163 d) and HIV-U (165 d) (P=0·004). Compared with HIV-N, being HIV-P was associated with about a 40 % higher risk of stopping EBF at any time point (HR 1·39; 95 % CI 1·06, 1·84; P=0·018) and less than half as likely to complete 6 months of EBF (adjusted OR 0·42; 95 % CI 0·22, 0·81; P=0·01). Being HIV-P tended to be or was associated with a higher risk of introducing non-milk liquids (HR 1·34; 95 % CI 0·98, 1·83; P=0·068), animal milks (HR 2·37; 95 % CI 1·32, 4·24; P=0·004) and solids (HR 1·56; 95 % CI 1·10, 2·22; P=0·011) during the first 6 months. Weight-for-age Z-score was associated with EBF and introducing formula. Different factors (ethnicity, food insecurity, HIV testing strategy) were associated with the various feeding behaviours, suggesting that diverse interventions are needed to promote optimal infant feeding.