Search

Background As part of the USDA-Department of Health and Human Services Pregnancy and Birth to 24 Months Project, we conducted systematic reviews (SRs) on topics important for health and nutrition of young children. Objectives The purpose of the present SR was to examine the relation between caregiver feeding practices in children from birth to 24 mo and child weight gain, size, and body composition. Methods A search of articles published from January 1980 to January 2017 in 4 databases identified 8739 references. Nutrition Evidence Systematic Review (NESR) analysts used the Nutrition Evidence Library Risk of Bias Assessment Tool to assess potential bias in the studies, and a Technical Expert Collaborative graded the body of evidence using the NESR grading rubric. Results Twenty-seven articles were included in this review (8 controlled trials, 19 longitudinal cohort studies). Moderate evidence from randomized controlled trials suggests that providing responsive feeding guidance to teach mothers to recognize and respond appropriately to children's hunger and satiety cues can lead to "normal" weight gain and/or "normal" weight status in children aged ≤2 y compared with children whose mothers did not receive responsive feeding guidance. Moderate evidence from longitudinal cohort studies indicates an association between maternal feeding practices and the child's weight status and/or weight gain, but the direction of effect has not been adequately studied. Restrictive feeding practices are associated with increased weight gain and higher weight status, and pressuring feeding practices are associated with decreased weight gain and lower weight status. Evidence suggests that a mother's feeding practices are related to concerns about her child's body weight. Conclusions This review highlights the importance of the interaction between caregivers and infants and toddlers related to child feeding practices on children's weight outcomes. Research is needed on more diverse populations with consistent methodological app-roaches and objective measures.

Background Maternal diet during pregnancy and lactation may provide the earliest opportunity to positively influence child food acceptance. Objective Systematic reviews were completed to examine the relation among maternal diet during pregnancy and lactation, amniotic fluid flavor, breast-milk flavor, and children's food acceptability and overall dietary intake. Design A literature search was conducted in 10 databases (e.g., PubMed, Embase, Cochrane, and CINAHL) to identify articles published from January 1980 to June 2017. Data from each included study were extracted, risk of bias assessed, evidence synthesized qualitatively, conclusion statements developed, and strength of the evidence graded. Results Eleven and 15 articles met a priori criteria for inclusion to answer questions related to maternal diet during pregnancy and lactation, respectively. Conclusions Limited but consistent evidence indicates that flavors (alcohol, anise, carrot, garlic) originating from the maternal diet during pregnancy can transfer to and flavor amniotic fluid, and fetal flavor exposure increases acceptance of similarly flavored foods when re-exposed during infancy and potentially childhood. Moderate evidence indicates that flavors originating from the maternal diet during lactation (alcohol, anise/caraway, carrot, eucalyptus, garlic, mint) transmit to and flavor breast milk in a time-dependent manner. Moderate evidence indicates that infants can detect diet-transmitted flavors in breast milk within hours of a single maternal ingestion (alcohol, garlic, vanilla, carrot), within days after repeated maternal ingestion (garlic, carrot juice), and within 1-4 mo postpartum after repeated maternal ingestion (variety of vegetables including carrot) during lactation. Findings may not generalize to all foods and beverages. Conclusions cannot be drawn to describe the relationship between mothers' diet during either pregnancy or lactation and children's overall dietary intake.

Background Millions of infants are fed breast milk substitutes, and the type of infant formula can impact weight gain patterns. Objective We conducted a randomized controlled trial to determine the direct impact of 2 types of infant formula (cow milk formula, CMF; extensively protein hydrolyzed formula, EHF) on growth and energy balance. Design A racially diverse group of formula-fed infants (n = 113) were randomly assigned to either CMF or EHF from the age of 0.75 to 12.5 mo. At each monthly visit, anthropometric measures were obtained to determine growth z scores and weight gain velocity, and to categorize early weight gain patterns as rapid or nonrapid. Also, diet records were collected to determine energy from formula and other sources. Comprehensive assessments of energy balance (intake, expenditure, loss) were made at 0.75, 3.5, and 12.5 mo. Results Beginning 3 wk after randomization, CMF infants had significantly higher weight, but not length, z scores than did EHF infants, and this persisted after solid foods complemented the formula diet. On average, weight gain velocity from 0.75 to 4.5 mo was within the range of typically growing infants for both groups, yet velocity was 3.9 g/d greater for CMF infants (P = 0.002), who were more likely to be classified as an early rapid weight gainer, than EHF infants (46% compared with 18%; P = 0.007). Early differences in energy intake and fecal loss, yielding greater energy available for deposition among CMF infants, contributed to the differential weight gain patterns. There were no significant differences between the formula treatment groups in total energy expenditure or sleeping energy expenditure. Conclusions Among healthy infants, the type of formula impacted on early rapid weight gain patterns owing to energy intake and loss mechanisms. Research is needed to identify the macronutrients and other compositional constituents in EHF and breast milk that promote satiation and healthy weight gain during sensitive periods of development. This trial was registered at clinicaltrials.gov as: NCT01700205.

Background Repeated exposure has been found to be an effective strategy to increase acceptability of foods in older children and adults, but little is known about its effectiveness in the birth to 24-mo population. Objectives This systematic review was conducted to examine the effects of repeated exposure to a single or multiple foods on acceptance of those or other foods among infants and toddlers. Methods A search was conducted for peer-reviewed articles related to food acceptability, flavor, taste, and infants and toddlers in 12 databases (e.g., PubMed, Embase, Cochrane, and CINAHL) with a date range of January 1980 to July 2017. The Nutrition Evidence Library (NEL) Bias Assessment Tool was used to assess potential bias in the included studies, and the NESR grading rubric was used to grade evidence supporting the conclusion statement. Results From the 10,844 references obtained, 21 studies (19 controlled trials and 2 longitudinal cohort studies) published from 1980 to 2015 were included in this review. Moderate evidence indicates that tasting a single vegetable or fruit or multiple vegetable(s) or fruit(s) 1 food per day for 8-10 or more days is likely to increase acceptability of an exposed food (indicated by an increase in intake or faster rate of feeding after comparison with before the exposure period) in infants and toddlers 4-24 mo old. The effect of repeated exposure on acceptability is likely to generalize to other foods within the same food category but not foods from a different food category. Findings are based on the effects of repeated exposure to mostly vegetables with some findings on repeated exposure to fruits. Conclusion This review advances the understanding of early food experiences and the development of food acceptability. Additional research is needed using diverse foods and textures with a focus on the transition to table foods.

Background The impact of feeding a slightly sweet nutrient supplement early in life on later sweet taste preference is unknown. Objective We tested the hypothesis that the level of sucrose most preferred by 4–6-y-old children exposed to a slightly sweet lipid-based nutrient supplement (LNS) early in life would not be higher than that of children never exposed to LNS. Design We followed up children born to women (n = 1,320) who participated in a randomized trial in Ghana. In one group, LNS was provided to women on a daily basis during pregnancy and the first 6 mo postpartum and to their infants from age 6 to 18 mo (LNS group). The control groups received daily iron and folic acid or multiple micronutrients during pregnancy and the first 6 mo postpartum, with no infant supplementation (non-LNS group). At age 4–6 y, we randomly selected a subsample of children (n = 775) to assess the concentration of sucrose most preferred using the Monell 2-series, forced-choice, paired-comparison tracking procedure. We compared LNS with non-LNS group differences using a noninferiority margin of 5% weight/volume (wt/vol). Results Of the 624 children tested, most (61%) provided reliable responses. Among all children, the mean ± SD sucrose solution most preferred (% wt/vol) was 14.6 ± 8.6 (LNS group 14.9 ± 8.7; non-LNS group 14.2 ± 8.4). However, among children with reliable responses, it was 17.0 ± 10.2 (LNS group 17.5 ± 10.4; non-LNS group 16.5 ± 10.0). The upper level of the 95% CI of the difference between groups did not exceed the noninferiority margin in either the full sample or those with reliable responses, indicating that the LNS group did not have a higher sweet preference than the non-LNS group. Conclusion Exposure to a slightly sweet nutrient supplement early in life did not increase the level of sweet taste most preferred during childhood. This trial was registered at clinicaltrials.gov as NCT00970866.

Health initiatives address childhood obesity in part by encouraging good nutrition early in life. This review highlights the science that shows that children naturally prefer higher levels of sweet and salty tastes and reject lower levels of bitter tastes than do adults. Thus, their basic biology does not predispose them to favor the recommended low-sugar, low-sodium, vegetable-rich diets and makes them especially vulnerable to our current food environment of foods high in salt and refined sugars. The good news is that sensory experiences, beginning early in life, can shape preferences. Mothers who consume diets rich in healthy foods can get children off to a good start because flavors are transmitted from the maternal diet to amniotic fluid and mother's milk, and breastfed infants are more accepting of these flavors. In contrast, infants fed formula learn to prefer its unique flavor profile and may have more difficulty initially accepting flavors not found in formula, such as those of fruit and vegetables. Regardless of early feeding mode, infants can learn through repeated exposure and dietary variety if caregivers focus on the child's willingness to consume a food and not just the facial expressions made during feeding. In addition, providing complementary foods low in salt and sugars may help protect the developing child from excess intake later in life. Early-life experiences with healthy tastes and flavors may go a long way toward promoting healthy eating, which could have a significant impact in addressing the many chronic illnesses associated with poor food choice.

Background: Epidemiology associates whole-grain (WG) consumption with several health benefits. Mounting evidence suggests that WG wheat polyphenols play a role in mechanisms underlying health benefits. Objective: The objective was to assess circulating concentration, excretion, and the physiologic role of WG wheat polyphenols in subjects with suboptimal dietary and lifestyle behaviors. Design: A placebo-controlled, parallel-group randomized trial with 80 healthy overweight/obese subjects with low intake of fruits and vegetables and sedentary lifestyle was performed. Participants replaced precise portions of refined wheat (RW) with a fixed amount of selected WG wheat or RW products for 8 wk. At baseline and every 4 wk, blood, urine, feces, and anthropometric and body composition measures were collected. Profiles of phenolic acids in biological samples, plasma markers of metabolic disease and inflammation, and fecal microbiota composition were assessed. Results: WG consumption for 4‐8 wk determined a 4-fold increase of serum dihydroferulic acid (DHFA) and a 2-fold increase of fecal ferulic acid (FA) compared with RW consumption (no changes). Similarly, urinary FA at 8 wk doubled the baseline concentration only in WG subjects. Concomitant reduction of plasma tumor necrosis factor-a (TNF-a) after 8 wk and increased interleukin (IL)-10 only after 4 wk with WG compared with RW (P = 0.04) were observed. No significant change in plasma metabolic disease markers over the study period was observed, but a trend toward lower plasma plasminogen activator inhibitor 1 with higher excretion of FA and DHFA in the WG group was found. Fecal FA was associated with baseline low Bifidobacteriales and Bacteroidetes abundances, whereas after WG consumption, it correlated with increased Bacteroidetes and Firmicutes but reduced Clostridium. TNF-a reduction correlated with increased Bacteroides and Lactobacillus. No effect of dietary interventions on anthropometry and body composition was found. Conclusions: WG wheat consumption significantly increased excreted FA and circulating DHFA. Bacterial communities influenced fecal FA and were modified by WG wheat consumption. This trial was registered at clinicaltrials.gov as NCT01293175. Am J Clin Nutr doi: 10.3945/ajcn.114.088120.

Background: What lactating mothers eat flavors breast milk and, in turn, modifies their infants' acceptance of similarly flavored foods.Objective: We sought to determine the effects of the timing and duration of eating a variety of vegetables during breastfeeding on the liking of vegetables in both members of the dyad.Design: We conducted a randomized controlled study of 97 mother-infant dyads. Lactating mothers drank vegetable, beet, celery, and carrot juices for 1 mo beginning at 0.5, 1.5, or 2.5 mo postpartum or for 3 mo beginning at 0.5 mo postpartum. The control group drank equal volumes of water and avoided drinking the juices. Mothers rated the tastes of the juices and self-reported dietary intakes at each monthly visit (0.5-4.5 mo). After weaning, when 7.9 mo of age, infants' acceptance of plain, carrot-flavor (exposed flavor), and broccoli-flavor (nonexposed flavor) cereals was assessed on separate days.Results: The timing of exposure affected the acceptance of the carrot flavor that did not generalize to the novel broccoli flavor. A relatively brief experience (1 mo) with vegetable flavors in mothers' milk, starting at 0.5 mo postpartum, was sufficient to shift the hedonic tone, which resulted in a faster rate of eating carrot-flavored cereal than that in infants who were exposed during subsequent months or not at all. One month of exposure had a greater effect than 3 mo of exposure or no exposure. Regardless of when exposure occurred, infants were less likely to display facial expressions of distaste initially when eating the carrot cereal. Over time, mothers liked the tastes of carrot, beet, and celery juices more, but no changes in dietary intake of vegetables were observed.Conclusions: Early life may be an optimum time for both infants and their mothers to learn to like the taste of healthy foods. More research is needed to facilitate the liking and eating of these foods by mothers, which will, in turn, increase the likelihood of their feeding these foods to their children. This trial was registered at clinicaltrials.gov as NCT01667549.

Background: We identified a model system that exploits the inherent taste variation in early feedings to investigate food preference development. Objective: The objective was to determine whether exposure to differing concentrations of taste compounds in milk and formulas modifies acceptance of exemplars of the 5 basic taste qualities in a familiar food matrix. Specifically, we examined the effects of consuming hydrolyzed casein formulas (HCFs), which have pronounced bitter, sour, and savory tastes compared with breast milk (BM) and bovine milk–based formulas (MFs), in which these taste qualities are weaker. Design: Subgroups of BM-, MF- and HCF-fed infants, some of whom were fed table foods, were studied on 6 occasions to measure acceptance of sweet, salty, bitter, savory, sour, and plain cereals. Results: In infants not yet eating table foods, the HCF group ate significantly more savory-, bitter-, and sour-tasting and plain cereals than did the BM or MF groups. HCF infants displayed fewer facial expressions of distaste while eating the bitter and savory cereals, and they and BM infants were more likely to smile while they were eating the savory cereal. In formula-fed infants eating table foods, preferences for the basic tastes reflected the types of foods they were being fed. In general, those infants who ate more food displayed fewer faces of distaste. Conclusions: The type of formula fed to infants has an effect on their response to taste compounds in cereal before solid food introduction. This model system of research investigation sheds light on sources of individual differences in taste and perhaps cultural food preferences.

Background: Alleles of the receptor gene TAS2R38 are responsible in part for the variation in bitter taste perception of 6-n-propylthiouracil (PROP) and structurally similar compounds (eg, glucosinolates in cruciferous vegetables). At low concentrations, people with the PAV (“taster” amino acid sequence) form of TAS2R38 perceive these bitter compounds, whereas most with the AVI (“nontaster” amino acid sequence) form do not; heterozygotes (PAV/AVI) show the widest range of bitter perception. Objectives: The objectives were to examine individual differences in expression of PAV-TAS2R38 messenger RNA (mRNA) among heterozygotes, to test the hypotheses that the abundance of allele-specific gene expression accounts for the variation in human bitter taste perception, and to relate to dietary intake of bitter-tasting beverages and foods. Design: Heterozygous individuals (n = 22) provided psychophysical evaluation of the bitterness of PROP, glucosinolate-containing broccoli juice, non–glucosinolate-containing carrot juice, and several bitter non-TAS2R38 ligands as well as dietary recalls. Fungiform taste papillae were examined for allele-specific TAS2R38 expression by using quantitative polymerase chain reaction. Results: PAV-TAS2R38 mRNA expression was measured in 18 of 22 heterozygous subjects. Relative expression varied widely and positively correlated with ratings of bitterness intensity of PROP (P = 0.007) and broccoli juice (P = 0.004) but not of the control solutions carrot juice (P = 0.26), NaCl (P = 0.68), caffeine (P = 0.24), or urea (P = 0.47). Expression amounts were related to self-reported recent and habitual caffeine intake (P = 0.060, P = 0.005); vegetable intake was too low to analyze. Conclusions: We provide evidence that PAV-TAS2R38 expression amount correlates with individual differences in bitter sensory perception and diet. The nature of this correlation calls for additional research on the molecular mechanisms associated with some individual differences in taste perception and food intake. The trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT01399944","term_id":"NCT01399944"}}NCT01399944.

Background: We recently discovered that infants randomly assigned to a formula high in free amino acids (extensive protein hydrolysate formula; ePHF) during infancy consumed less formula to satiation and gained less weight than did infants fed an isocaloric formula low in free amino acids (cow milk formula; CMF). Objective: Because ePHF and CMF differ markedly in concentrations of free glutamate, we tested the hypothesis that the higher glutamate concentrations in ePHF promote satiation and satiety. Design: In this counterbalanced, within-subject study, infants ,4 mo of age (n = 30) visited our laboratory for 3 sets of 2 consecutive infant-led formula meals over 3 test days. Infants were fed 1 of 3 isocaloric formulas during each first meal: CMF, ePHF, or CMF with added free glutamate to approximate concentrations in ePHF (CMF+glu). When infants signaled hunger again, they were fed a second meal of CMF. From these data, we calculated satiety ratios for each of the 3 formulas by dividing the intermeal interval by the amount of formula consumed during that particular first meal. Results: Infants consumed significantly less CMF+glu (P , 0.02) and ePHF (P , 0.04) than CMF during the first meals. They also showed greater levels of satiety after consuming CMF+glu or ePHF: satiety ratios for CMF+glu (P , 0.03) and ePHF (P , 0.05) were significantly higher than for CMF. Conclusion: These findings suggest a role of free glutamate in infant intake regulation and call into question the claim that formula feeding impairs infants’ abilities to self regulate energy intake. This trial was registered at clinicaltrials.gov as NCT00957892. Am J Clin Nutr 2012;95:875‐81.

Background: By using the response to protein hydrolysate formula (PHF) as a model system, we discovered the existence of a sensitive period, before 4 mo, when exposure determines the hedonic tone to flavors. Objective: We aimed to characterize the timing and duration of this sensitive period. Design: Healthy infants, whose parents had chosen formula feeding, were randomly assigned into 1 of 6 groups at age 0.5 mo: 2 control groups, one fed cow milk–based formula (CMF) and the other fed PHF for 7 mo; 2 groups fed PHF for either 1 or 3 mo beginning at 1.5 mo and CMF otherwise; and 2 groups fed PHF for 1 mo beginning at either 2.5 or 3.5 mo and CMF otherwise. Brief access taste tests were conducted monthly, and complete “meals” of both formulas occurred at the end of the study. Results: Three months of PHF exposure led to acceptance similar to that at 1 mo of exposure. Although these infants were more accepting than were infants with no exposure, they were less accepting than were infants with 7 mo of exposure, which suggests a dosing effect. The time when flavor experiences began was also significant. Among infants exposed to PHF for 1 mo, those who were first fed PHF at 3.5 mo rejected PHF relative to CMF more than did infants exposed at younger ages. Conclusion: The general principles observed are likely of broader significance, indicating a fundamental feature of mammalian development and reflecting the importance of familiarizing infants with flavors that their mothers consume and transmit to breast milk. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00994747","term_id":"NCT00994747"}}NCT00994747.

Background: Research in humans and animal models suggests that acceptance of solid foods by infants during weaning is enhanced by early experiences with flavor variety. Objective: We tested the hypotheses that the acceptance of novel foods by formula-fed infants could be facilitated by providing the infants with a variety of flavors at the time when beikost is first introduced and that, contrary to medical lore, infants who had previously consumed fruit would be less likely to reject vegetables when first introduced than would infants without such an experience. Design: The infants’ acceptance of a novel vegetable (pureed carrot) and a novel meat (pureed chicken) was evaluated after a 9-d exposure period in 3 groups of infants, some of whom had previously consumed fruit. During the home-exposure period, one group was fed only carrots, the target vegetable; a second group was fed only potatoes, a vegetable that differed in flavor from carrots; and a third group was fed a variety of vegetables that did not include carrots. Results: Infants fed either carrots or a variety of vegetables, but not those fed potatoes, ate significantly more of the carrots after the exposure period. Exposure to a variety of vegetables also facilitated the acceptance of the novel food, pureed chicken, and daily experience with fruit enhanced the infants’ initial acceptance of carrots. Conclusion: These findings are the first experimental evidence to indicate that exposure to a variety of flavors enhances acceptance of novel foods in human infants. Am J Clin Nutr 2001;73:1080‐5.