Abstract
Background: Complementary feeding practices play an important role in nutrition-related outcomes. Despite concerns that baby food pouch use may lead to overfeeding or suboptimal eating behaviour development, there is no published research investigating these outcomes in infants. Similarly, concern has been expressed about the use of Baby-Led Weaning (BLW) as an alternative to traditional spoon-feeding (TSF), however, current evidence is limited.
Objectives: This thesis aimed to investigate relationships between complementary feeding practices (baby food pouches and BLW) and energy intake, weight status, appetite-related eating behaviours and infant fullness cues.
Methods: Data were collected for 625 infants aged 7-10 months as part of the First Foods New Zealand study. Baby food pouch use and BLW were assessed by questionnaire. Infants were classified as ‘frequent pouch users’ if they had been given food from a commercial baby food pouch 5+ times per week in the past month. ‘Full’ BLW, ‘partial’ BLW or TSF were defined based on the relative proportions of adult spoon-feeding versus infant self-feeding. Daily energy intake was determined using two 24-hour dietary recalls. Trained researchers measured infant length and weight, and body mass index (BMI) z-scores were calculated using World Health Organization Child Growth Standards. Appetite-related eating behaviours were assessed using the Children’s Eating Behaviour Questionnaire (‘satiety responsiveness’, ‘slowness in eating’, ‘food responsiveness’ and ‘enjoyment of food’ subscales) and the Toddler-Parent Mealtime Behavior Questionnaire (‘picky eater’ subscale). Caregivers reported infant eating duration as part of the 24-hour dietary recalls. A subsample of participants (n=204) videoed the infant eating in their home environment. Video footage was coded and used to assess eating duration, and determine the types and frequency of 16 different fullness cues.
Results: Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; -19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4) and food fussiness (0.3; 0.1, 0.4). Compared to TSF, ‘full’ BLW was associated with greater daily energy intake (mean difference, 180 kJ/day; 95% CI 62, 299), but not BMI z-score (0.06; -0.13, 0.26). ‘Full’ BLW infants had significantly higher satiety responsiveness (standardised mean difference, 0.4; 95% CI 0.2, 0.6), and lower food responsiveness (-0.3; -0.5, -0.1) and food fussiness (-0.2; -0.4, -0.0) than their TSF counterparts. There was no evidence of a difference in eating speed between frequent and less frequent or non pouch users, although frequent pouch users spent significantly less time eating during the videoed eating occasion (mean difference, -3.1 minutes, 95% CI -5.9, -0.2). ‘Full’ BLW infants were slightly slower eaters than those who were TSF (mean difference, -3 kJ/minute; -6, -1), and scored higher on the ‘slowness in eating’ subscale (0.6; 0.5, 0.8). Nearly all (n=13/16) fullness cues were observed in the video subsample, and the frequency of fullness cues was positively associated with the proportion of spoon-feeding during the eating occasion.
Conclusion: These results showed no evidence that either frequent pouch use or BLW were associated with weight status, despite BLW infants having greater energy intake compared with TSF. However, frequent pouch use and BLW were associated with several appetite-related eating behaviours, including food responsiveness and food fussiness. Eating speed was not related to frequent pouch use, but infants who followed BLW were slower eaters when compared to spoon-fed infants. Fullness cues were more frequently observed in TSF infants. Overall, these findings indicate that complementary feeding practices may influence outcomes concerning appetite regulation.