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Traditional fermented millet gruel is frequently eaten by children in Burkina Faso as a complementary food or for breakfast. The effects of gruel energy density and feeding style on intakes (amounts and energy) were assessed in children in Ouagadougou. Twenty-three young children (11 infants and 12 toddlers) were given two meals of gruel per day for two periods of 11 consecutive days, first, the traditional fermented gruel (TFG), and second, an improved high energy density fermented gruel (IFG). On the first 10 days of each period, the children were fed as usual, while on the 11th day, the mothers were asked to use encouraging feeding. Intakes of TFG and IFG were also measured once a day for nine days in 25 preschoolers (2-5 years-old). After adjustment for the subject effect, IFG intakes did not significantly differ from TFG intakes in the groups of infants and toddlers, meaning there was a significant increase in energy intakes, which almost doubled. Encouraging feeding increased TFG intakes in both age groups, but IFG intakes only increased in toddlers, whose energy intake tripled compared to that from TFG with the usual feeding style. In preschoolers, mean IFG intakes were lower than TFG intakes and there were no increase in mean energy intakes. Improving fermented gruel and training the mothers to encourage their young children during feeding are two possible strategies to improve food intakes, and hence to better satisfy the children's nutritional needs., (Copyright © 2016. Published by Elsevier Ltd.)

The aim of this study was to test the ability of two new products, an instant infant flour and a food supplement containing amylases, to increase energy and micronutrient intakes of infants older than 6 months. Three groups of 48 infants were randomly constituted. Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement. Infants from the control group received complementary foods prepared in the usual way. Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed. Foods consumed by infants in the two experimental groups differed considerably in energy, micronutrient density and in consistency from the home-made complementary foods. Due to the incorporation of amylases, gruels made from the food supplement had a higher energy density, a more appropriate consistency and resulted in higher intakes per meal than gruels made from instant flour. In comparison with home-made complementary foods, both experimental products resulted in significantly higher energy and nutrient intakes. The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake.

Background/objectives: The assessment of child feeding practices has received renewed attention through the development of an infant and child feeding index (ICFI). However, the advantages and shortcomings of such a summary index are still not well known. The aim of this study was to assess the usefulness of ICFI as an analytical tool (1) by studying its association with complementary food energy intake and mean micronutrient density adequacy (MMDA) and (2) by testing whether ICFI and its components are associated with length-for-age z-score (LAZ) of 6-23 months children in urban Madagascar., Subjects/methods: ICFI was constructed using data from questionnaires on feeding practices and quantitative 24-h recalls (n=1589). Multivariate analysis was used to control for household wealth and other confounding factors., Results: ICFI was positively correlated with complementary food energy intake (P<0.0001) and MMDA (P<0.0001). ICFI was associated with LAZ among 6-8 months children (P=0.02). For all ages combined, there was a tendency towards an association that did not reach statistical significance (P=0.08). Among feeding practices that formed ICFI, breastfeeding was associated with LAZ (P=0.03) but not in the expected direction with +0.16 z-score difference in favour of non-breast-fed children. When breastfeeding was removed and introduced separately into the multivariate model, the relationship between the modified ICFI and LAZ became significant (P=0.02)., Conclusions: Findings suggest that the ICFI could be a useful analytical tool, which needs however to be constructed according to its final use and which should be adapted to each context.

Objective: To assess the effect of the incorporation of amylase in maize-based flours prepared as gruels on the energy intake and growth of Congolese infants., Design: A randomised controlled trial. At 18 weeks of age, infants were randomised into either an intervention group, where they were provided with a maize/soya-based flour that contained amylase, or a control group, where they were provided with a similar flour that did not contain amylase., Setting: Urban borough of Poto-Poto in Brazzaville, The Congo., Subjects: Eighty infants (40 in each group) were randomised into intervention and control groups. Three infants in the intervention group and two controls subsequently dropped out., Results: At 24 weeks, the addition of amylase resulted in a significant increase in energy intake (in kJ kg-1 day-1) from gruels without affecting breast milk consumption. In contrast, total energy intake (in kJ kg-1 day-1) did not differ significantly between groups (P= 0.08). After adjustment for morbidity and previous growth, infants in the intervention group showed better growth in length during the trial (+0.22 cm month-1; P= 0.04), especially between 24 and 31 weeks of age (+0.51 cm month-1; P< 0.01). There were no differences in weight velocity between groups., Conclusions: The findings of this study suggest that the consumption of amylase-treated gruels allows an increase in energy intake from these gruels without affecting breast milk consumption but has no impact on total daily energy intake. However, if started after 6 months, it could be effective in preventing faltering of infant linear growth.

In free living conditions, 24 breastfed infants, aged 6 to 10 months, were given successively five experimental gruels to study the effect of energy density (ED) and sweetness (sweet taste) on energy intakes (EI). Four gruels (G0, G1, G9 and G20) were prepared with experimental flours which were composed of the same local ingredients and which contained different levels of sucrose. The fifth gruel (GC) was prepared with an industrial flour. G0 had an average ED of 45 kcal/100 g (189 kJ/100 g) and the other gruels an average ED of 110 kcal/100 g (461 kJ/100 g). Although the sugar contents of the flours were 1% for G1, 9% for G0 and G9 and 20% for G20, because of flour composition and gruel dry matter content, the gruel G1 had the same sweetness as G0, G20 the same sweetness as GC and G9 a sweetness between that of G1 and G20. The results show that the amounts of G0 consumed were significantly higher than those of high ED gruels (7.84 for G0 vs 6.12, 5.63, 4.46, 4.72 g/kg body weight/meal, respectively for G20, G9, G1 and GC, P < 0.05). However, EI from high ED gruels were significantly (P < 0.001) higher than those from G0 (6.65, 6.10, 4.86, 4.83 kcal/kg/meal, respectively for G20, G9, G1 and GC vs 3.46 for G0). Energy intakes from G9 and G20 gruels were not significantly different but were significantly higher than those from GC and G1 (P < 0.001). So, consumption of sweet gruels with high ED and composed of local ingredients increased, at least by 76%, the EI from gruels in comparison with those from low ED gruels, but the amounts consumed by the infants remained too low to cover more than 15% of their daily total energy needs.

Forty market samples of locally produced (33) and imported (7) cereal-based flours used for complementary feeding in some African countries and Vietnam were studied in order to characterise their macronutrient content and, when prepared as gruels, their viscosity, energy density, and osmolality. The results show that less than half were fairly balanced with respect to their protein and lipid content. When prepared as gruels following the manufacturers' instructions, out of the 21 locally produced flours with complete instructions, ten had energy densities too low to provide sufficient energy to complement breastmilk for 9-11-month-old infants even at three meals a day (< 77 kcal or 322 kJ/100 g), nine were satisfactory if fed more than twice a day, and two if fed twice a day (> 116 kcal or 485 kJ/100 g). Two of the 11 with acceptable energy density had osmolality values higher than those reported in literature for complementary feeding (< 660 mOsm/kg H2O). In addition, when prepared as gruels with viscosities within the range of viscosity (1 to 3 Pa.s) usually observed in African countries, 14 of the 32 (44%) locally produced flours had insufficient energy densities to meet the energy requirements of infants even at three meals a day. These results call for greater concern and effort towards improving the nutritive value and energy density of cereal-based complementary foods produced in developing countries.

It has been known for at least 25 years that high energy density and low viscosity are desirable attributes of complementary foods. However, the effects of increasing energy density and reducing viscosity of gruels on infant energy intake have only been studied in the last 10 years. Works published between 1986 and 1992 were carried out with infants randomly selected in urban slums or rural areas in India and Tanzania. When gruels are given in a single meal, all of them showed higher energy intake with both high energy-dense and low viscosity gruels. But these studies do not give information about the effects of these gruels on daily energy intake from gruels and on total daily energy intake when they are given with feeding frequencies corresponding to traditional weaning practices. Works published since 1992 were conducted among infants suffering from or recovering from acute diarrhoea or severe malnutrition. A positive effect of increasing energy density of gruels was observed not only on energy intake from gruels but also on total energy intake. On the other hand, effectiveness of reducing viscosity was not clearly demonstrated. Further studies are required, particularly to identify the conditions for which high energy dense gruels prepared from bulk-reduced starchy staples are able to significantly improve infant energy intake.