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Protein-Reduced Complementary Foods Based on Nordic Ingredients Combined with Systematic Introduction of Taste Portions Increase Intake of Fruits and Vegetables in 9 Month Old Infants: A Randomised Controlled Trial
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.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
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2019 (English)In: Nutrients, E-ISSN 2072-6643, Vol. 11, no 6, article id 1255Article in journal (Refereed) Published
Abstract [en]

Fruits and vegetables are healthy foods but under-consumed among infants and children. Approaches to increase their intake are urgently needed. This study investigated the effects of a systematic introduction of taste portions and a novel protein-reduced complementary diet based on Nordic foods on fruit and vegetable intake, growth and iron status to 9 months of age. Healthy, term infants (n = 250) were recruited and randomly allocated to either a Nordic diet group (NG) or a conventional diet group (CG). Infants were solely breast- or formula-fed at study start. From 4 to 6 months of age, the NG followed a systematic taste portions schedule consisting of home-made purées of Nordic produce for 24 days. Subsequently, the NG was supplied with baby food products and recipes of homemade baby foods based on Nordic ingredients but with reduced protein content compared to the CG. The CG was advised to follow current Swedish recommendations on complementary foods. A total of 232 participants (93%) completed the study. The NG had significantly higher intake of fruits and vegetables than the CG at 9 months of age; 225 ± 109 g/day vs. 156 ± 77 g/day (p < 0.001), respectively. Energy intake was similar, but protein intake was significantly lower in the NG (−26%, p < 0.001) compared to the CG. This lower protein intake was compensated for by higher intake of carbohydrate from fruits and vegetables. No significant group differences in growth or iron status were observed. The intervention resulted in significantly higher consumption of fruits and vegetables in infants introduced to complementary foods based on Nordic ingredients.

Place, publisher, year, edition, pages
MDPI, 2019. Vol. 11, no 6, article id 1255
Keywords [en]
infant feeding, Nordic diet, eating behaviour, repeated exposure
National Category
Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:umu:diva-161926DOI: 10.3390/nu11061255ISI: 000474936700061PubMedID: 31159495Scopus ID: 2-s2.0-85067185540OAI: oai:DiVA.org:umu-161926DiVA, id: diva2:1340767
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2023-08-28Bibliographically approved
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)
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Supervisors
Available from: 2021-11-19 Created: 2021-11-08 Last updated: 2022-03-07Bibliographically approved

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