Research reportDevelopment of healthy eating habits early in life. Review of recent evidence and selected guidelines☆
Highlights
► Review of literature on the development of eating habits during weaning. ► Well-covered themes are influence of exposure, role of variety and parental styles. ► Evaluation of international and selected national feeding guidelines. ► Guidelines in general cover most of the themes, but some of them are incomplete. ► Guidelines should give more practical tips to parents.
Introduction
Balanced nutrition early in life is essential for health later in life. After birth, infants receive breast milk or formula milk, and their nutritional intake is fully dependent on the nutritional value of these milks which cover most macro- and micro-nutritional needs. After a few months, milk is no longer sufficient to meet the energy and nutritional requirements of a child (Butte et al., 2002, Reilly et al., 2005, Reilly and Wells, 2005) contemporaneously to the depletion of body iron stores. At this age, the amount of milk that should be consumed to provide the child with enough energy and nutrients is too large in comparison to a child's stomach size. The fact that milk is no longer nutritionally sufficient is one of the main reasons to start introducing the infant with complementary foods, i.e. weaning. Weaning is defined here as the gradual introduction of beverages and foods other than breast milk or commercial infant formulas. Ultimately, weaning should lead to the consumption of foods that are nutritionally complete and balanced, and that fit in the culture of the family and the country. Weaning is also important to help the child acquire an optimal behaviour toward eating, a competence that is necessary for an optimal transition from milk to table foods and family foods after the first year of life. Moreover, since food preferences have been shown to take shape early in life and track further on until adulthood (Devine et al., 1998, Nicklas et al., 1991, Nicklaus et al., 2004, Nicklaus et al., 2005, Skinner et al., 2002), an optimal introduction of weaning foods will have an impact on the development of healthy eating habits, both short and longer term. In the light of the rising prevalence of diet-related diseases such as childhood obesity, the development of healthy eating habits early in life may be one of the ways to prevent the onset of these diseases (Birch & Ventura, 2009).
During the weaning process, different types of food are offered to infants, including vegetables, fruits, starchy foods such as cereals and potatoes, meat, fish and dairy products. There is no harmonized approach in the way these foods are introduced and different countries have different weaning strategies (Maier, Chabanet, Schaal, Issanchou, & Leathwood, 2007a). International and national recommendations and guidelines have been developed to guide parents in the transition from milks to foods. These guidelines differ especially in their focus on either developed or developing countries and in the physiological and behavioural reasons underlying the introduction of weaning foods. Additionally, national guidelines contain culture-specific recommendations that differ from country to another.
The first objective of the current review was first to summarise the latest scientific evidence on the different themes that are mostly relevant during the phase of introducing complementary foods, with a specific focus on the behavioural aspects of weaning (Part 1). Based on a previously proposed approach (Butte et al., 2004), each theme was categorized as being related to the timing (when), the nutritional and sensory properties (what), or the approach (how). The second objective was to evaluate to what extent selected international and country-specific feeding guidelines cover recent scientific evidence for each of the selected themes (Part 2). Given the importance of early childhood in establishing healthy eating habits, the scope of this review was the period ranging from the beginning of weaning until the age of three years, in accordance with some national guidelines or regulation (INPES, 2004, Lace, in press). Both parts of the paper will use the categorization of themes and topics as shown in Fig. 1.
Section snippets
Literature review
A literature search was conducted in the 1st trimester of 2010 using the electronic platform Science direct and the electronic databases Pubmed and Web of Science. Citations in the resulting publications were also used to identify relevant references. For the search terms we took inspiration from the publication by Pac et al. (2004). Search terms included: eating, feeding, feeding behaviour, feeding practice, food acceptance, food habits, food neophobia, food portion, food preference, food
When: initiation and progress in feeding – timing
One of the main reasons to start with complementary foods is because milks are no longer sufficient to meet the nutritional requirements (Butte et al., 2002, Reilly et al., 2005). Because weaning is also associated with an increased risk of microbial contamination especially in developing countries, recommendations on the timing of weaning are partly based on a risk assessment between maintaining adequate growth and maintaining a low infection risk (WHO, 2003b). From a physiological
Part 2: analysis and comparison of the selected guidelines
The comparative analysis of the selected guidelines is summarised in Table 1. The themes are commented and discussed below.
Conclusion
This review helps to identify themes related to the early development of healthy eating that might need more research and/or more attention in international and national guidelines. It may help to encourage research and development of updated guidelines.
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This project was funded by a grant from Danone Research – Centre for Specialised Nutrition. The present review was conducted as part of a collaborative project between Centre des Sciences du Goût et de l’Alimentation (UMR6265 CNRS, UMR1324 INRA, Université de Bourgogne, Agrosup Dijon) and Danone Research – Centre for Specialised Nutrition. Funding came from Danone Research – Centre for Specialised Nutrition.