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Acceptance of a Nordic, Protein-Reduced Diet for Young Children during Complementary Feeding: A Randomized Controlled Trial
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. (Torbjörn Lind)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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2021 (English)In: Foods, E-ISSN 2304-8158, Vol. 10, article id 275Article in journal (Refereed) Published
Abstract [en]

Early life is critical for developing healthy eating patterns. This study aimed to investigate the effects of a Nordic, protein-reduced complementary diet (ND) compared to a diet following the current Swedish dietary guidelines on eating patterns and food acceptance. At 4–6 months (mo) of age infants were randomized to a Nordic group (NG, n = 41) or a Conventional group (CG, n = 40), and followed until 18 mo of age. Daily intake of fruits and vegetables (mean ± sd) at 12 mo was significantly higher in the NG compared to the CG: 341 ± 108 g/day vs. 220 ± 76 g/day (p < 0.001), respectively. From 12 to 18 mo, fruit and vegetable intake decreased, but the NG still consumed 32% more compared to the CG: 254 ± 99 g/day vs. 193 ± 67 g/day (p = 0.004). To assess food acceptance, both groups were tested with home exposure meals at 12 and 18 mo. No group differences in acceptance were found. We find that a ND with parental education initiates healthy eating patterns during infancy, but that the exposure meal used in the present study was insufficient to detect major differences in food acceptance. This is most likely explained by the preparation of the meal. Nordic produce offers high environmental sustainability and favorable taste composition to establish healthy food preferences during this sensitive period of early life.

Place, publisher, year, edition, pages
Basel: MDPI, 2021. Vol. 10, article id 275
Keywords [en]
infant feeding, healthy eating, food preference, eating behavior, repeated exposure, vegetables, fruits, sustainable eating, environment
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-181856DOI: 10.3390/foods10020275ISI: 000622535800001Scopus ID: 2-s2.0-85102421382OAI: oai:DiVA.org:umu-181856DiVA, id: diva2:1540308
Funder
Region Västerbotten, VLL-644531Region Västerbotten, VLL-488901Region Västerbotten, VLL- 677921Region Västerbotten, VLL-761381Available from: 2021-03-29 Created: 2021-03-29 Last updated: 2023-09-05Bibliographically 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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Johansson, UlricaÖhlund, IngerHernell, OlleLind, Torbjörn

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