Abstract
Background: Baby-led weaning (BLW) and the use of “baby” food pouches are two novel approaches to infant feeding that are becoming increasingly popular both in New Zealand and internationally. Although some health agencies have expressed concerns about these approaches’ potential negative health impacts for infants, and subsequently for children, there is virtually no research in the area. Baby-led weaning’s impact on nutrition and health in infancy has been sparsely investigated, however no research to date explores how baby-led weaning in infancy affects children later in life. Furthermore, there has been no research on the use or impact of “baby” food pouches on nutrition and health in young children. The term “baby” food pouch is used here to describe food packaged in a pouch with a spout, and that is intended for consumption by infants and young children.
Aim: To describe “baby” food pouch use, and to determine whether using “baby” food pouches or baby-led weaning has an effect on nutrient intake and body mass index in 1-3.9-year-old New Zealand children.
Methods: The Young Foods New Zealand (YFNZ) study was an observational, cross-sectional study carried out in Dunedin, Wellington, and Auckland (New Zealand). Participants underwent two appointments with a trained researcher. A subset of the YFNZ data (dietary, anthropometric, and questionnaire data) were used for this thesis. Participants were aged 12 months to 3.9 years of age.
Data on usual energy and nutrient intake were collected using two 24-h recalls, one at each of two appointments approximately a week apart. The 24-h recall data were entered and then adjusted using the Multiple Source Method (MSM) to provide estimates of usual intake (1).
Data on “baby” food pouch use were collected using the main questionnaire in the first appointment, including the frequency, method of use, time and place “baby” food pouches were consumed, and parental reasons for liking and disliking pouches. Frequent pouch use was defined as eating from a pouch 5 or more times per week. Less or non-frequent pouch use was defined as using a pouch at some point since solids were started but currently using them fewer than 5 or more times a week.
Data on baby-led weaning were collected by questionnaire in the first appointment, including how the child was fed at 6 months of age, whether baby-led weaning was used, and how old the child was when baby-led weaning was tried.
Body Mass Index (BMI) Z-score was determined from anthropometric measurements in the first appointment. The child’s weight and length or height was measured. Body mass index was calculated as weight in kg divided by height in meters squared and BMI-for-age-z-scores were determined using the World Health Organisation growth standards (2).
Results: The majority (85%) of children had used a pouch at some point in their life, however only 11% were considered ‘frequent’ pouch users. Sixty-five percent of young children consumed the contents by sucking straight from the nozzle. The most common locations where pouches were consumed were: chair (23%), highchair (26%) and “while on the go” (23%).
Total sugars intake was 14g (22%, approximately 3.3 teaspoons) higher in toddlers who frequently consumed “baby” food pouches than those who consumed them less frequently (CI: 5.8, 22.3). There were no other differences in nutrient intake for toddlers. Protein was 12%, iron 19% and zinc 11% lower in preschoolers who frequently consumed “baby” food pouches than those who consumed them less frequently, with a mean difference of -6.1g (CI -11.5, -0.7), -1.03mg (CI -1.9, -0.2) and -0.7mg (CI: -1.2, -0.1) respectively. Body mass index-z-score did not differ between frequent and non-frequent pouch users, in either toddlers or preschoolers.
Carbohydrate intake was lowest in toddlers who followed baby-led weaning at 6 months of age (117g) compared to partial baby-led weaning (124g) or traditional spoon-feeding (135g) (p-value 0.024). No energy or nutrient differences were observed between groups for preschoolers. Body-mass-index-Z-score was not found to be different between full or partial baby-led weaning or traditional spoon-feeding in either toddlers or preschoolers.
Conclusions: While most young children had tried a “baby” food pouch at some point in their life, relatively few were considered frequent pouch users, suggesting that pouches are not contributing to a significant portion of most young New Zealand children’s diets. However, over half of pouch users sucked the contents directly from the nozzle, and this may have implications for dental health and motor skills.
Total sugars intake was 22% higher in toddlers with frequent pouch use, and protein, iron and zinc were 12%, 19% and 11% lower in preschoolers with frequent pouch use. This is an observational study but suggests that frequent pouch use may have influenced nutrient intake in both toddlers and preschoolers. For complementary feeding style, the only nutrient with differing intake was carbohydrate, which was lowest in toddlers who followed baby-led weaning, however no differences were found in preschoolers. These results suggest that any differences in nutrient intake that might be seen during baby-led weaning, do not persist beyond infancy.