Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceAmong working mothers, delaying return to work until at least six months was associated withlater introduction of solid foods. 131The nature of the weaning diet varied by mother’s socio-economic status. When compared withother women, mothers in managerial/professional occupations were more likely to feed theirinfants cooked vegetables and fruit, rice and pasta, and meat and fish, and less likely to provideregular servings of sweets, biscuits and savoury snacks. 131There are two large cohort studies of UK infants in which variations in complementary feeding andweaning practice and dietary intakes have been assessed: ALSPAC and the Southampton Women’sSurvey (SWS). The ALSPAC study collected dietary data using three-day diet diaries for over 1,000infants born in 1991-92. 135, 136 At eight months, 34 per cent of the infants had not eaten any fruitand 25 per cent had not eaten vegetables in the three-day study period, while 26 per cent of theinfants had eaten chocolate. At 18 months, 16 per cent of the children had not eaten fruit and 8per cent had not eaten vegetables in the three-day period but 63 per cent of the children hadeaten chocolate and 66 per cent had eaten savoury snacks. Although intakes of most nutrientswere above the reference nutrient intakes (considered adequate for 97% of children), vitamin Dintakes were low at both ages, and iron intakes were low at 18 months.The ALSPAC study also showed that at 18 months, the most common container for drinks was atrainer cup. Eighty-six per cent of children had at least one drink from a trainer cup over a 24-hourperiod, 64 per cent of children were given at least one drink in a bottle, and 10 per cent solelyused a bottle. Use of a bottle was more common among children who had not been breastfed,who had older siblings, and who had mothers who smoked. 137 Children being fed milk in a bottleconsumed greater volumes when compared with children given milk in a cup; this was particularlymarked for the children only fed by bottle. A wide variety of drinks were given at this age,including low calorie squashes (48%), tea and coffee (17%), and fizzy drinks (7%). Maternaleducation was the most important factor associated with the types of drinks consumed at this age– more highly educated mothers gave their children fruit juices more often, whereas women withlow levels of educational attainment were more likely to give their children tea, coffee and softdrinks. Seventeen per cent of children whose mothers had Certificate of Secondary Education(CSE) qualifications or less were given fizzy drinks over a 24-hour period.More recently the dietary patterns of 1,434 infants born to women in the SWS between 1999-2003were reported. 138 The most important pattern of diet identified at both six months and 12 monthsof age was consistent with current infant feeding guidance, and was characterised by highconsumption of vegetables, fruit, meat and fish, and other home-prepared foods. This dietarypattern was labelled the ‘infant guidelines’ pattern. Infants who had high scores for this patternof feeding were also more likely to have been breastfed. A number of factors, including a rangeof maternal and family characteristics were considered as influences on the infants’ pattern scores.At both ages the key determinant of the nature of the infant diet was the quality of the mother’sdiet. Infants whose mothers had high prudent diet scores and ‘healthier’ dietary patterns,characterised by high intakes of fruits and vegetables, and wholemeal bread, 139 were more likely tohave a comparable diet, and were fed in accordance with infant feeding guidelines. Conversely,mothers who had low prudent diet scores and whose diets were characterised by high intakes ofwhite bread and chips, added sugar and full-fat dairy products, were less likely to provide a diet fortheir infant that conformed with infant feeding guidance (see Figure 10). The influence ofmother’s dietary pattern on her infant’s diet was independent of a range of other factors, includingher educational attainment and smoking status.32Early life nutrition and lifelong health