A quasi-experimental intervention protocol to characterize the factors that influence the acceptance of new foods by infants: mothers' diet and weaning method. Dastatuz project

Iratxe Urkia-Susin, Diego Rada-Fernandez de Jauregui, Estibaliz Orruño, Edurne Maiz, Olaia Martinez, Iratxe Urkia-Susin, Diego Rada-Fernandez de Jauregui, Estibaliz Orruño, Edurne Maiz, Olaia Martinez

Abstract

Background: Children usually refuse to eat and taste fruits and vegetables; and turning unhealthy eating habits around is an important social challenge in industrialized countries. The Dastatuz project aims to study children food neophobia and to enhance fruit and vegetable acceptance.

Methods: A quasi-experimental, multicentre, controlled and prospective intervention study is proposed, in which early factors influencing new food acceptance will be studied. Mothers in the third trimester of pregnancy (n = 144) and their infants will be the study population. Experimental groups will be established based on mothers´ fruit and vegetable intake (standard or high intake) and weaning method (baby lead weaning vs spoon feeding). The project will assess the possible impact of maternal diet and complementary feeding on infants eating behaviour until 18 months of age. Outcome measures will comprise maternal diet and psychological features during pregnancy and breast-feeding (validated questionnaires). Compositional and physicochemical analysis of milk during breastfeeding will also be carried out. During weaning, until 18 months of age, children's diet will be assessed with 24 h recalls and acceptance of new fruits and vegetables will be studied using video recording.

Discussion: If the intervention is effective, this research work would have a high potential to be transferred to future public health programs or nutrition guidelines, as a feasible solution to achieve a higher intake of fruits and vegetables among children.

Trial registration: This study is registered at ClinicalTrials.gov. Identifier: NCT04262102 . Registration date: February 10, 2020 - Retrospectively registered.

Keywords: Baby-led weaning; Breastfeeding; Children food neophobia; Dietary intervention; Early factors; Fruits and vegetables; Maternal diet.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of the Dastatuz project. Legend: Main stages: 3rd trimester of pregnancy, breastfeeding and weaning and complementary feeding until the children are 18 months old. Q1, Q2, Q3, Q4, Q4’and Q4´´ refer to online questionnaires in each stage
Fig. 2
Fig. 2
General procedure for the child observation events at 6, 12 and 18 months from birth

References

    1. Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc. 2004;104(Suppl. 1):57–64. doi: 10.1016/j.jada.2003.10.024.
    1. Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: a longitudinal study to age 11years. Eat Behav. 2010;11(4):253–257. doi: 10.1016/j.eatbeh.2010.05.006.
    1. Werthmann J, Jansen A, Havermans R, Nederkoorn C, Kremers S, Roefs A. Bits and pieces. Food texture influences food acceptance in young children. Appetite. 2015;84:181–187. doi: 10.1016/j.appet.2014.09.025.
    1. D’Auria E, Bergamini M, Staiano A, Banderali G, Pendezza E, Penagini F, et al. Baby-led weaning: what a systematic review of the literature adds on. Ital J Pediatr. 2018;44(1):1–11. doi: 10.1186/s13052-018-0487-8.
    1. Nekitsing C, Blundell-Birtill P, Cockroft JE, Hetherington MM. Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2–5 years. Appetite. 2018;127:138–154. doi: 10.1016/j.appet.2018.04.019.
    1. American Psychiatric Association and others . Diagnostic and statistical manual of mental disorders (DSM-V). American Psychiatric Pub. 2013.
    1. Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. J Eat Disord. 2017;5(1):1–10. doi: 10.1186/s40337-017-0149-z.
    1. Manikam R, Perman J. Pediatric feeding disorders. J Clin Gastroenterol. 2000;30(1):34–46. doi: 10.1097/00004836-200001000-00007.
    1. Dovey TM, Staples PA, Gibson EL, Halford JCG. Food neophobia and “picky/fussy” eating in children: a review. Appetite. 2008;50(2–3):181–193. doi: 10.1016/j.appet.2007.09.009.
    1. Bryant-Waugh R, Micali N, Cooke L, Eddy K, Thomas J. The Pica, ARFID, and rumination disorder interview: development of a multi-informant, semi-structured interview of feeding disorders across the lifespan. Prep. 2018;52(4):1–10. 10.1002/eat.22958.
    1. Harris G, Mason S. Are there sensitive periods for food acceptance in infancy? Curr Nutr Rep. 2017;6(2):190–196. doi: 10.1007/s13668-017-0203-0.
    1. Ventura AK, Worobey J. Early influences on the development of food preferences. Curr Biol. 2013;23(9):R401–R408. doi: 10.1016/j.cub.2013.02.037.
    1. Nederkoorn C, Theiβen J, Tummers M, Roefs A. Taste the feeling or feel the tasting: tactile exposure to food texture promotes food acceptance. Appetite. 2018;120:297–301. doi: 10.1016/j.appet.2017.09.010.
    1. Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum NN, Norat T, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029–56. 10.1093/ije/dyw319.
    1. EL Evans C, Christian MS, Cleghorn CL, Greenwood DC, Cade JE. Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y. Am J Clin Nutr. 2012;96(4):889–901. doi: 10.3945/ajcn.111.030270.
    1. Kim SA, Moore LV, Galuska D, Wright AP, Harris D, Grummer-Strawn LM, et al. Vital signs: fruit and vegetable intake among children - United States, 2003-2010. MMWR Morb Mortal Wkly Rep. 2014;63(31):671–6 .
    1. Mennella JA, Reiter AR, Daniels LM. Vegetable and fruit acceptance during infancy: impact of Ontegeny, genetics, and early experiences. Adv Nutr An Int Rev J. 2016;7(12):211–219. doi: 10.3945/an.115.008649.
    1. Marcos Suarez V, Rubio Mañas J, Sanchidrián Fernández R. Robledo de Dios T. Spanish national dietary survey on children and adolescents. EFSA Support Publ. 2017;12(11):4–11. doi: 10.2903/sp.efsa.2015.en-900.
    1. WHO . WHO European Childhood Obesity Surveillance Initiative (COSI) [Internet]. World Health Organization. 2019.
    1. Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat. 2016;12:213–218. doi: 10.2147/NDT.S82538.
    1. Watson S, Costantini C, Clegg ME. The role of complementary feeding methods on early eating behaviors and food Neophobia in toddlers. Child Care Pract. 2018;26(1):94–106. doi: 10.1080/13575279.2018.1516625.
    1. Taylor RW, Williams SM, Fangupo LJ, Wheeler BJ, Taylor BJ, Daniels L, et al. Effect of a baby-led approach to complementary feeding on infant growth and overweight: a randomized clinical trial. JAMA Pediatr. 2017;171(9):838–46. 10.1001/jamapediatrics.2017.1284.
    1. Hart CN, Raynor HA, Jelalian E, Drotar D. The association of maternal food intake and infants’ and toddlers’ food intake. Child Care Health Dev. 2010;36(3):396–403. doi: 10.1111/j.1365-2214.2010.01072.x.
    1. Maier AS, Chabanet C, Schaal B, Leathwood PD, Issanchou SN. Breastfeeding and experience with variety early in weaning increase infants’ acceptance of new foods for up to two months. Clin Nutr. 2008;27(6):849–857. doi: 10.1016/j.clnu.2008.08.002.
    1. Mennella JA, Johnson A, Beauchamp GK. Garlic ingestion by pregnant women alters the odor of amniotic fluid. Chem Senses. 1995;20(2):207–209. doi: 10.1093/chemse/20.2.207.
    1. Schaal B, Marlier L, Soussignan R, Nouzilly F, De BU, Picardet RA, et al. Human foetuses learn odours from their pregnant mother’s diet. Chem Senses. 2000;25(6):729–737. doi: 10.1093/chemse/25.6.729.
    1. Shim JE, Kim J, Mathai RA. Associations of infant feeding practices and picky eating behaviors of preschool children. J Am Diet Assoc. 2011;111(9):1363–8. .
    1. Mennella JA, Beauchamp GK. Experience with a flavor in mother’s milk modifies the infant’s acceptance of flavored cereal. Dev Psychobiol. 1999;35(3):197–203 .
    1. Spahn JM, Callahan EH, Spill MK, Wong YP, Benjamin-neelon SE, Birch L, et al. Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children ’ s responses : a systematic review. Am J Clin Nutr. 2019;109(Suppl):1003S–1026S. doi: 10.1093/ajcn/nqy240.
    1. Hausner H, Nicklaus S, Issanchou S, Mølgaard C, Møller P. Breastfeeding facilitates acceptance of a novel dietary flavour compound. Clin Nutr. 2010;29(1):141–148. doi: 10.1016/j.clnu.2009.11.007.
    1. Sandgruber S, Much D, Amann-Gassner U, Hauner H, Buettner A. Sensory and molecular characterisation of human milk odour profiles after maternal fish oil supplementation during pregnancy and breastfeeding. Food Chem. 2011;128(2):485–494. doi: 10.1016/j.foodchem.2011.03.058.
    1. Nicklaus S. The role of food experiences during early childhood in food pleasure learning. Appetite. 2015;104:3–9. doi: 10.1016/j.appet.2015.08.022.
    1. Cameron SL, Heath ALM, Taylor RW. Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, baby-led weaning: a content analysis study. BMJ Open. 2012;2(6):1–9. doi: 10.1136/bmjopen-2012-001542.
    1. Pérez-Ríos M, Santiago-Pérez MI, Butler H, Mourino N, Malvar A, Hervada X. Baby-led weaning: prevalence and associated factors in Spain. Eur J Pediatr. 2020;179(6):849–853. doi: 10.1007/s00431-020-03579-7.
    1. Rapley G, Murkett T. Baby-led weaning: helping your baby love good food. London: Random House; 2008. pp. 20–23.
    1. D’Andrea E, Jenkins K, Mathews M, Roebothan B. Baby-led weaning: a preliminary investigation. Can J Diet Pract Res a Publ Dietitians Canada. 2016;77(2):72–77. doi: 10.3148/cjdpr-2015-045.
    1. Cameron SL, Taylor RW, Heath ALM. Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families. BMJ Open. 2013;3(12):1–9. doi: 10.1136/bmjopen-2013-003946.
    1. Dogan E, Yilmaz G, Caylan N, Turgut M, Gokcay G, Oguz MM. Baby-led complementary feeding: a randomized controlled study. Pediatr Int. 2018;(12):1073–80. 10.1111/ped.1367160.
    1. Brown A, Jones SW, Rowan H. Baby-led weaning: the evidence to date. Curr Nutr Rep. 2017;6(2):148–156. doi: 10.1007/s13668-017-0201-2.
    1. Cameron SL, Taylor RW, Heath ALM. Development and pilot testing of baby-led introduction to SolidS - a version of baby-led weaning modified to address concerns about iron deficiency, growth faltering and choking. BMC Pediatr. 2015;15(1):1–11. doi: 10.1186/s12887-015-0422-8.
    1. Brown A, Lee MD. Early influences on child satiety-responsiveness: the role of weaning style. Pediatr Obes. 2015;10(1):57–66. doi: 10.1111/j.2047-6310.2013.00207.x.
    1. Demonteil L, Tournier C, Marduel A, Dusoulier M, Weenen H, Nicklaus S. Longitudinal study on acceptance of food textures between 6 and 18 months. Food Qual Prefer. 2019;71(April 2018):54–65. doi: 10.1016/j.foodqual.2018.05.010.
    1. Harris G, Coulthard H. Early eating Behaviours and food acceptance revisited: breastfeeding and introduction of complementary foods as predictive of food acceptance. Curr Obes Rep. 2016;5(1):113–120. doi: 10.1007/s13679-016-0202-2.
    1. Mennella J, Jagnow C, Beauchamp G. Prenatal and postnatal flavor learning by human infants. Pediatrics. 2001;107(6):1–12. doi: 10.1542/peds.107.6.e88.
    1. Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database Syst Rev. 2018;2018(5). 10.1002/14651858.CD011768.pub2.
    1. Nieland M, Roger D. Emotion control and analgesia in labour. Pers Individ Dif. 1993;14(6):841–843. doi: 10.1016/0191-8869(93)90098-N.
    1. Behrenz KM, Monga M. Fatigue in pregnancy: a comparative study. Am J Perinatol. 1999;16(4):185–188. doi: 10.1055/s-2007-993855.
    1. Reeves N, Potempa K, Gallo A. Fatigue in early pregnancy. An exploratory study. J Nurse Midwifery. 1991;36(5):303–309. doi: 10.1016/0091-2182(91)90045-Q.
    1. Ranta P, Spalding M, Kangas-Saarela T, Jokela R, Hollmén A, Jouppila P, et al. Maternal expectations and experiences of labour pain--options of 1091 Finnish parturients. Acta Anaesthesiol Scand. 1995;39(1):60–66. doi: 10.1111/j.1399-6576.1995.tb05593.x.
    1. Oliver-Roig A, D’Anglade-González M-L, García-García B, Silva-Tubio J-R, Richart-Martínez M, Dennis C-L. The Spanish version of the breastfeeding self-efficacy scale-short form: reliability and validity assessment. Int J Nurs Stud. 2012;49(2):169–173. doi: 10.1016/j.ijnurstu.2011.08.005.
    1. Kendall S, Bloomfield L. Developing and validating a tool to measure parenting self-efficacy. J Adv Nurs. 2005;51(2):174–181. doi: 10.1111/j.1365-2648.2005.03479.x.
    1. González-Merlo J, Del Sol J. Obstetricia. 4. Barcelona: Masson; 2002.
    1. Smith R. Netter: Obstetricia, Ginecología y Salud de la Mujer. 1. Barcelona: Masson; 2006.
    1. DeCosta P, Møller P, Frøst MB, Olsen A. Changing children’s eating behaviour - a review of experimental research. Appetite. 2017;113:327–357. doi: 10.1016/j.appet.2017.03.004.
    1. Arlinghaus KR, Vollrath K, Hernandez DC, Momin SR, O’Connor TM, Power TG, et al. Authoritative parent feeding style is associated with better child dietary quality at dinner among low-income minority families. Am J Clin Nutr. 2018;108(4):730–736. doi: 10.1093/ajcn/nqy142.
    1. Fries LR, Martin N, van der Horst K. Parent-child mealtime interactions associated with toddlers’ refusals of novel and familiar foods. Physiol Behav. 2017;176:93–100. doi: 10.1016/j.physbeh.2017.03.001.
    1. Jordan AA, Appugliese DP, Miller AL, Lumeng JC, Rosenblum KL, Pesch MH. Maternal prompting types and child vegetable intake: exploring the moderating role of picky eating. Appetite. 2020;146:104518. doi: 10.1016/j.appet.2019.104518.
    1. Ministerio de Agricultura P y A . Informe del Consumo en España 2017 [Internet]. Madrid. 2018.
    1. Hetherington MM, Madrelle J, Nekitsing C, Barends C, De Graaf C, Morgan S, et al. Developing a novel tool to assess liking and wanting in infants at the time of complementary feeding – the feeding infants : behaviour and facial expression coding system ( FIBFECS ) Food Qual Prefer. 2016;48:238–250. doi: 10.1016/j.foodqual.2015.09.010.
    1. Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, et al. A 14-item mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED trial. PLoS One. 2012;7(8). 10.1371/journal.pone.0043134.
    1. Rodriguez VM, Elbusto-Cabello A, Alberdi-Albeniz M, De la Presa-Donado A. Gómez-Pérez de Mendiola F, Portillo-Baquedano MP, et al. New pre-coded food record form validation. Rev Española Nutr Humana y Dietética. 2014;18(3):118–126. doi: 10.14306/renhyd.18.3.84.
    1. Hattersley S, Ward R, Baka A, Crevel RWR. Advances in the risk management of unintended presence of allergenic foods in manufactured food products - an overview. Food Chem Toxicol. 2014;67:255–261. doi: 10.1016/j.fct.2014.01.036.
    1. Crevel RWR . Food allergen risk assessment and management [Internet]. Handbook of Food Allergen Detection and Control. Woodhead Publishing Limited. 2015. pp. 41–66.
    1. Birot S, Madsen CB, Kruizinga AG, Christensen T, Crépet A, Brockhoff PB. A procedure for grouping food consumption data for use in food allergen risk assessment. J Food Compos Anal. 2017;59:111–123. doi: 10.1016/j.jfca.2017.01.008.
    1. Lasa A, Larretxi I, Simón E, Churruca I, Navarro V, Martínez O, et al. New software for gluten-free diet evaluation and nutritional education. Nutrients. 2019;11(10). 10.3390/nu11102505.
    1. Armengol Asenjo R, Chamarro Lusar A. Teresa García-Dié Muñoz M, Lusar C. Aspectos psicosociales en la gestación: el Cuestionario de Evaluación Prenatal. An Psicol. 2007;23(1):25–32.
    1. Jover M, Colomer J, Carot JM, Larsson C, Bobes MT, Ivorra JL, et al. Maternal anxiety following delivery, early infant temperament and mother’s confidence in caregiving. Span J Psychol. 2014;17(2014):1–12. 10.1017/sjp.2014.87.
    1. Garcia-Esteve L, Ascaso C, Ojuel J, Navarro P. Validation of the Edinburgh postnatal depression scale (EPDS) in Spanish mothers. J Affect Disord. 2003;75(1):71–76. doi: 10.1016/S0165-0327(02)00020-4.
    1. Oronoz B, Alonso-arbiol I, Balluerka N. A Spanish adaptation of the parental stress scale. Psicothema. 2007;19(4):687–692.
    1. Wardle J, Sanderson S, Guthrie CA, Rapoport L, Plomin R. Parental feeding style and the intergenerational transmission of obesity risk. Obes Res. 2002;10(6):453–462. doi: 10.1038/oby.2002.63.
    1. Nekitsing C, Madrelle J, Barends C, de Graaf C, Parrott H, Morgan S, et al. Application and validation of the feeding infants: behaviour and facial expression coding system (FIBFECS) to assess liking and wanting in infants at the time of complementary feeding. Food Qual Prefer. 2016;48:228–37. 10.1016/j.foodqual.2015.09.012.

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