Supplementation of certain micronutrients is recommended to ensure their adequate supply during pregnancy and lactation. In Germany, this applies particularly to folic acid and iodine. There is no ...nationwide data on adherence to the supplementation guidelines. The aim of this cross‐sectional study was to determine the prevalence and predictors of the recommended supplementation of both folic acid and iodine in mothers of a nationwide birth cohort. Data on supplementation, before, during, and shortly after pregnancy, were collected retrospectively 14 days postpartum in a sample of 962 mother–infant pairs participating in the second nationwide study on breastfeeding and infant nutrition in Germany, called “SuSe II” (2017–2019). Folic acid and iodine supplementation were classified as recommended according to the German guidelines if supplementation was provided for both essential periods: for folic acid before and during pregnancy and for iodine during pregnancy and lactation. Univariable tests and multivariable logistic regression analysis were performed. The vast majority of mothers did not adhere to the recommendations, with only 36.2% supplementing folic acid and 31.9% supplementing iodine during the recommended periods, and only 15.2% adhering to the recommendations for both nutrients. Main predictors of adherence to recommendations of both nutrients were lifestyle attributes and nutrition‐related intentions like previous breastfeeding experience and breastfeeding intentions, but not common sociodemographic characteristics. The data suggest widespread dissemination of the time‐specific recommendations covering the entire period from preconception to lactation that could help to sensitize women and healthcare providers.
Breastfeeding promotion and support in hospitals is expected to have a positive impact on maternal breastfeeding outcomes. The objective of this study is to examine the association between ...breastfeeding promotion in maternity hospitals in Germany and exclusive breastfeeding (EBF) rates during the first 4 months. Thus, a nationwide cross‐sectional web‐based survey of breastfeeding promotion was conducted in 103 hospitals. Mother–infant pairs (n = 962) were recruited at these hospitals for a prospective web‐based survey of breastfeeding status at five‐time points, that is, during a hospital stay, at discharge as well as after 0.5, 2, and 4 months. The hospital analysis was based on the “10 Steps to Successful Breastfeeding” of the World Health Organization and the United Nations Children's Fund, adapted for Germany. Their degree of implementation was stratified by a breastfeeding promotion index (BPI) as low (≤5 steps), medium (6–8 steps), and high (≥9 steps). The association between the BPI and the odds of EBF at each of the five‐time points was estimated by multivariable regression models, adjusting for various maternal factors. At all time points, the proportion of EBF among mothers from high BPI hospitals exceeded the proportion of those from medium or low BPI hospitals. A high BPI was associated with higher odds of EBF during the hospital stay and at discharge, while maternal factors for EBF such as breastfeeding experience and no early use of a pacifier persisted beyond. The high commitment of hospitals and tailored support of mothers is essential for EBF.
By repeated assessments of breastfeeding status during the first 4 months after birth in a nationwide survey, it was shown that a high level of breastfeeding promotion in the hospital is necessary to get exclusive breastfeeding (EBF) started. Modifiable and nonmodifiable maternal factors remained relevant for EBF beyond the hospital period. Thus, high breastfeeding engagement of hospitals needs to be complemented by tailored pre‐ and postdischarge support for mothers as a critical component of sustained breastfeeding success.
Key messages
A high breastfeeding promotion index (BPI) favours exclusive breastfeeding (EBF) in the hospital environment, while maternal factors persisted beyond.
Even in a country with a high level of maternal and child care, breastfeeding promotion in hospitals plays a significant role in the successful start of breastfeeding.
Maternal factors, primarily breastfeeding experience and no early use of a pacifier, were persistent and stronger predictors of EBF than the BPI.
The steps that need to be improved most refer to breastfeeding information, early breastfeeding initiation, and alternative feeding methods.
High hospital commitment complemented by tailored, individualised postdischarge support of mothers are critical components for sustained breastfeeding success.
With the introduction of complementary food, long-chain PUFA (LC-PUFA) supply usually decreases during the second 6 months of life. However, the need for LC-PUFA is still high for infant's rapid ...development. The aim of this randomized, controlled intervention trial was to examine the effects of an increased n-3 (LC-)PUFA supply using alternative complementary foods on infants' visual and cognitive development.
Mother-child dyads of term infants were recruited in maternity hospitals and randomly assigned to one of three study groups, which all were fed according to the German dietary schedule for infant nutrition. Intervention group IG-R (n = 54) received jars of complementary food with rapeseed oil, IG-F (n = 48) jars with oily fish twice a week and the control group (CG, n = 58) the same jars as IG-R with corn oil instead of rapeseed oil during the intervention period (5th-10th month of age). The outcome measures were latencies of FVEP, Bayley's mental developmental index (MDI), and psychomotor developmental index (PDI).
At 10 months of age, there were no significant differences in latencies of FVEP, Bayley's MDI, or in PDI index between the intervention and control groups.
Fish and rapeseed oil used as (LC-)PUFA sources provided with complementary feeding embedded in a structured infant diet did not affect visual or cognitive development of term infants.
This systematic review aims to evaluate previous findings on the dose-related effects of short- and long-term physical activities (PA) on executive functions (EF) using a new approach by considering ...the success of experimental manipulation. Eight electronic databases were searched between May 2021 and September 2021. Randomized control trials among healthy children (6–12 years) were screened. Data extraction included the measurement of experimental manipulations and pre–post measurements of physical fitness. After identifying 1774 records, 17 studies were included (nine short-term PA and eight long-term PA). The overall results suggest that a single 20-min PA may be overwhelming for short-term EF in children up to 9 years of age but may be beneficial for children 9 years and older. A dose-related relationship between PA and EF could not be verified in long-term studies, which is possibly due to insufficient fitness gains and participation in the intervention. Short- and long-term endurance and coordination training could improve children’s executive functions, but so far, there is no specific evidence on the duration, frequency, and intensity of PA. Not quantity but quality of intervention seems to be important in this context. Further intervention studies are needed that control for the characteristics of the experimental manipulation.
Following a request from the European Commission to EFSA, the EFSA Scientific Committee (SC) prepared a guidance for the risk assessment of substances present in food intended for infants below ...16 weeks of age. In its approach to develop this guidance, the EFSA SC took into account, among others, (i) an exposure assessment based on infant formula as the only source of nutrition; (ii) knowledge of organ development in human infants, including the development of the gut, metabolic and excretory capacities, the brain and brain barriers, the immune system, the endocrine and reproductive systems; (iii) the overall toxicological profile of the substance identified through the standard toxicological tests, including critical effects; (iv) the relevance for the human infant of the neonatal experimental animal models used. The EFSA SC notes that during the period from birth up to 16 weeks, infants are expected to be exclusively fed on breast milk and/or infant formula. The EFSA SC views this period as the time where health‐based guidance values for the general population do not apply without further considerations. High infant formula consumption per body weight is derived from 95th percentile consumption. The first weeks of life is the time of the highest relative consumption on a body weight basis. Therefore, when performing an exposure assessment, the EFSA SC proposes to use the high consumption value of 260 mL/kg bw per day. A decision tree approach is proposed that enables a risk assessment of substances present in food intended for infants below 16 weeks of age. The additional information needed when testing substances present in food for infants below 16 weeks of age and the approach to be taken for the risk assessment are on a case‐by‐case basis, depending on whether the substance is added intentionally to food and is systemically available.
This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2017.EN-1248/full
To apply for the first time FAO/WHO standards for Food Based Dietary Guidelines (FBDG) to develop a total diet concept named Optimized Mixed Diet (OMD) for children and adolescents in a European ...country.
Exact 7-day menus were composed for sample age groups of children (4-6 years) and adolescents (13-14 years), taking into account the German meal patterns, common non-fortified foods, and sensory preferences of children (practical criteria). Food amounts and food selection within the menus were optimized so far as to achieve a total of reference intakes for 22 nutrients (scientific criteria). Simple food based messages were deduced.
Compared to the existing high-fat, low plant food diet reported from the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study), the OMD is lower in fat and saturated fatty acids and contains ample amounts of plant foods. Reference nutrient densities for age groups between 1 and 18 years were achieved or exceeded, except folate. Foods from the optimized menus were summarized into 11 food groups based on nutritional and practical considerations. Proportions of food groups by weight are independent of age and can be used to recalculate food amounts for various age groups or energy requirements, respectively. For simplification, "recommended" foods were distinguished from "tolerated" foods by their nutrient densities; based on food amounts, 3 simple rules for food consumption were deduced, i.e. beverages and plant foods: ample; animal foods: moderate; high-fat, high-sugar foods: sparingly.
Exact menus and food amounts are a prerequisite to ascertain nutrient adequacy of FBDG. The OMD demonstrates that a single diet concept with a core of quantified food groups can be adequate for age groups between 1 and 18 years within a country, such as Germany.
Evidence indicates low 25-hydroxyvitamin D (25(OH)D concentrations in European adolescents. Identification of potential determinants is therefore essential to guide public health initiatives aiming ...at optimizing vitamin D status across Europe. The aim of the study was to identify potential influencing factors of 25(OH)D concentrations in European adolescents aged 12.5 to 17.5 y, participating in the multi-centre cross-sectional Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. A subset of 1,006 participants (46.8% males) was drawn from the main study. Measures of body composition, biochemical markers, socioeconomic status, dietary intake, physical activity, fitness, sleep time and vitamin D genetic polymorphism (rs1544410) were assessed. Stepwise multivariate linear regression analysis was conducted stratified by gender. In males, linear regression of 25(OH)D, suggested that (1) winter season (β=−0.364; p<0.01), (2) higher latitudes (β=−0.246; p<0.01), (3) BMI z-score (β=−0.198; p<0.05) and (4) retinol concentration (β=0.171; p<0.05) independently influenced 25(OH)D concentrations. In females, (1) winter season (β=−0.370; p<0.01), (2) sleep time (β=−0.231; p<0.01), (3) supplement intake (β=0.221; p<0.05), (4) flexibility (β=0.184; p<0.05), (5) body fat % (β=0.201; p<0.05) (6), BMI z-score (β=−0.272; p<0.05), (7) higher latitudes (β=−0.219; p<0.01) and (8) handgrip strength (β=0.206; p<0.05) independently influenced 25(OH)D concentrations. Season, latitude, fitness, adiposity, sleep time and micronutrient supplementation were highly related to 25(OH)D concentrations found in European adolescents.
Recently, the European Food Safety Authority (EFSA) issued a tolerable daily intake (TDI) for erucic acid, which is mainly found in rapeseed oil. Infants may be exposed to erucic acid from rapeseed ...oil indirectly through maternal consumption via breastmilk or the fat component in formula, and directly as a part of complementary feeding (CF). To check the safety of infant nutrition, scenarios for erucic acid exposure were calculated based on the daily food amounts of the German dietary guidelines. Information on erucic acid concentrations in foods was obtained from European studies for breastmilk, from EFSA samples for formula powder, and from a representative analysis of rapeseed oil samples in the German retail market. 6 scenarios were calculated for the early milk feeding phase (4 formula feeding, 2 breastfeeding) and 8 scenarios for the later CF phase (5 CF +formula feeding, 3 CF +breastfeeding). Out of the 14 scenarios, only 3 resulted in exposures that were definitively below the TDI (range 4.4.–6.0 mg/kg bodyweight; BW). Assuming either high consumption or high concentration led to high exceedances (range 7.5–26.2 mg/kg BW), especially in case of the new EU limits for formula or vegetable oils (33.6 and 43.2 mg/kg BW, respectively). In our scenarios, high erucic acid exposures occurred during a particularly sensitive developmental period. To definitively weigh the potential risks from erucic acid in infants against nutritional benefits of the dietary recommendations, reliable, timely data on erucic acid in breast milk and formula are needed, similar to those from rapeseed oil in Germany.
In infancy, the diet requires both, an especially high nutritional quality and toxicological safety. In view of the recent TDI for erucic acid issued by EFSA, our scenarios show that the nutritionally safe food‐based dietary guidelines for infancy in Germany may no longer be safe with regard to potential exposure to erucic acid that originates mainly from rapeseed oil. In addition to the strong data base on erucic acid in rapeseed oil in Germany, timely data bases for human milk and formula are needed to definitely decide on the toxicological safety of infant nutrition.
Adolescence is recognized as a time of rapid physiological and behavioral change. In this transition, eating behavior is still being formed and remains an integral part of a person’s lifestyle ...throughout his or her life. This study aims to assess eating behavior and associations with food intake in European adolescents. We included 2194 adolescents (45.9% boys), aged 12.5 to 17.5 years, from the cross-sectional HELENA study, with two completed 24 h recalls and complete questionnaire data on their eating behavior (Eating Behavior and Weight Problems Inventory for Children- EWI-C). Three subscales of the EWI were evaluated; they measured Strength and motivation to eat (EWI 1), Importance and impact of eating (EWI 2), and Eating as a means of coping with emotional stress (EWI 3). Since these subscales were specially focused on eating behavior, participants were classified as either Low (≤P75) or High (>P75) on each of the subscales. Our results showed a higher consumption of different types of food, in the EWI 1 scales, linked to the hunger and interest in eating, and we observed a relationship with the consumption of energy-dense products. This result was repeated in EWI 3, the subscale linked to emotional eating, where we also found higher consumption of energy-dense products. This study suggests that special features of eating behavior are associated with food intake in adolescents.
This study investigated the relationship between different levels of physical fitness and cognitive functions in boys and girls. Schoolchildren from a comprehensive school in Germany (
= 211, 39% ...girls, 5th and 6th grade) attended regular or sport-focused classes with different numbers of physical education (PE) classes per week (3 vs. 5-6 h). Performance of physical fitness was tested according to endurance, strength, speed, coordination and flexibility. Four computerized instruments (switch task, 2-back task, Corsi block-tapping task and flanker task) were used to test cognitive functions. Additional predictors, sex, age, PE class, Body Mass Index and physical activity, were included in analyses. The results showed that physical fitness was associated with improved attention and memory functions in children, although the associations were mostly small. After Bonferroni correction, mainly coordination was related to improved cognition. Physical activity, i.e., step counts, PE class and sex were associated with specific cognitive outcomes. These findings may be important for effective health promotion, and supporting children's education in the school environment. Sex-specific physical activities in school could potentially lead to greater cognitive benefits in children. Randomized trials are needed to replicate these results.
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