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A randomized, controlled trial of a Nordic, protein-reduced complementary diet: effects on dietary intake, biomarkers and growth until 18 months of age
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.ORCID iD: 0000-0002-0830-889x
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.ORCID iD: 0000-0002-8522-2766
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Plant-based foods introduced during complementary feeding (CF) can contribute to long-term health andclimate friendly diet, but longitudinal multicomponent approaches are lacking.

Objectives: To investigate the effects of a protein-reduced, Nordic complementary diet on dietary intake, biomarkers andgrowth and compared to the current Swedish dietary recommendations for infants until 18 mo of age.

Design: Healthy, term infants (n=250) were recruited and randomly allocated to either a Nordic diet group (NG) or aconventional diet group (CG). From 4-6 mo of age, the NG followed a taste portions schedule with Nordic fruitand vegetables. From 6 mo up to 18 mo of age, the NG was supplied with Nordic homemade baby food recipes,protein-reduced baby food products and parental support. The CG followed the current Swedish dietaryrecommendations for infants. Dietary intake data, biomarkers and anthropometry were collected frombaseline up to 18 mo of age.

Results: Of the 250 infants, 82% (n=206) completed the study. The NG consumed daily 42-45% more fruit andvegetables compared to the CG at 12 and 18 mo of age (p<0.001). Plasma folate was higher in the NGcompared to the CG at 12 mo (p<0.001) and 18 mo of age (p=0.003) and protein intake and blood ureanitrogen (BUN) were lower at both 12 and 18 mo of age (p<0.001). There were no group differences in energyintake (EI), growth, iron status or other biomarkers.

Conclusions: The NG consumed significantly more plant-based Nordic foods compared to CG, a difference that lasted at leastuntil 18 mo of age. The lower protein intake in the NG had no effect on growth or iron status. The introductionof a protein-reduced, Nordic diet during CF is safe and feasible, and benefits a sustainable environment andhealth already during infancy and early childhood. 

Keywords [en]
infant feeding, early nutrition, infancy, repeated exposure, fruit, vegetables, sustainable eating, environment, plant-based food, healthy diet.
National Category
Pediatrics
Research subject
Medicine; Medicine; Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-189171OAI: oai:DiVA.org:umu-189171DiVA, id: diva2:1609331
Available from: 2021-11-08 Created: 2021-11-08 Last updated: 2021-11-11
In thesis
1. Complementary feeding based on Nordic foods: effects on nutrient intake, growth, biomarkers and eating behavior
Open this publication in new window or tab >>Complementary feeding based on Nordic foods: effects on nutrient intake, growth, biomarkers and eating behavior
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Tilläggskost med nordisk mat : effekt på näringsintag, tillväxt, biomarkörer och ätbeteende
Abstract [en]

Background: Early nutrition is fundamental to growth and development. Infants develop long lasting food preferences very early in life from food exposures when the brain is impressionable and sensory pathways are receptive. Early food experiences from bitter and sour tastes found in fruits and vegetables can establish longlasting food preferences and healthy eating behavior. Fruits and vegetables can protect against future non-communicable diseases such as cardiovascular diseases, type 2 diabetes, overweight, obesity and cancer. Nordic fruits, berries and vegetables offer high environmental sustainability and favorable taste compositionto establish a variety of food preferences. In this thesis, the focus is on early feeding among healthy, full-term infants and how to establish eating based on Nordic foods.

Methods: The thesis is based on the randomized, controlled trial Optimized complementary feeding study (OTIS), with three papers on the outcomes of the trial and one validation paper. In the trial, the experimental Nordic group (n=125) consumed a diet based on Nordic foods, reduced in protein whereas the control group (n=125) followed the current nutritional recommendations for infants from the Swedish Food Agency. The Nordic group was exposed to a variety of flavors from Nordic, homemade fruit, berry and vegetable purées according to a taste portion schedule with repeated exposures for 24 days during 4-6 months of age. From 6 to 18 months of age the Nordic group experienced a multicomponent intervention of homemade Nordic baby food recipes, family recipes and protein-reduced baby food products together with parental support through social media. The control group followed the Swedish recommendations on how to introduce taste portions and solid foods and were supplied with commercial baby food products with regular content. At baseline, 9, 12 and 18 months of age anthropometry, blood samples, urine samples, questionnaires and dietary data were collected.

Results: Of the 250 infants, 82% (n=206) finished the study until 18 months of age. The attrition rate was higher in the Nordic group (p=0.012). The Nordic group consumed more plant-based foods as fruits, berries, roots and vegetables during the entire study period except at 6 months of age. The protein intake was higher in the control group throughout the study. Plasma urea was higher in the control group as a response to the higher protein intake and plasma folate was higher in the Nordic group as a reflection of the higher fruit and vegetables intake. There were no differences in growth, total energy intake, iron status, breastfeeding durationor any demographic variables between the groups.

Conclusions: A Nordic diet, reduced in protein, increasedthe daily intake of fruit, berries, roots and vegetables, establishing a preferable eating pattern lasting over 12 months. Parental support and systematical flavor learning of Nordic foods may have impacted the infants’ dietary intake in the Nordic group. The Nordic diet is both feasible and safe for infants’ growth, nutritional requirements and development during complementary feeding period between 4-18 months of age. Thus, it may serve as a healthy and environmentally sustainable alternative to future infants and their parents.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2021. p. 105
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2137
Keywords
Infant feeding, healthy diet, food preference, complementary feeding, eating behavior, repeated exposure, vegetables, fruit, Nordic diet, sustainable diet, nutrition, roots, berries, flavor learning
National Category
Pediatrics
Research subject
Pediatrics; Medicine; Nutrition; Public health
Identifiers
urn:nbn:se:umu:diva-189172 (URN)978-91-7855-552-9 (ISBN)
Public defence
2021-12-10, Bergasalen, Byggnad 27, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-11-19 Created: 2021-11-08 Last updated: 2022-03-07Bibliographically approved

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