Conduite de la diversification alimentaire en France : les données de la cohorte ELFE

National audienc

Factors associated with food texture acceptance in 4- to 36-month-old french children: Findings from a survey study

International audienceFood texture plays an important role in food acceptance by young children, especially during the complementary feeding period. The factors driving infant acceptance of a variety of food textures are not well-known. This study summarizes maternal reports of children’s ability to eat foods of different textures (here: acceptance) and associated factors. Mothers of 4- to 36-month-old children (n = 2,999) answered an online survey listing 188 food-texture combinations representing three texture levels: purees (T1), soft small pieces (T2), hard/large pieces, and double textures (T3). For each offered combination, they reported whether it was spat out or eaten with or without difficulty by the child. A global food texture acceptance score (TextAcc) was calculated for each child as an indicator of their ability to eat the offered textured foods. The results were computed by age class from 4–5 to 30–36 months. The ability to eat foods without difficulty increased with age and was ranked as follows: T1> T2 > T3 at all ages. TextAcc was positively associated with exposure to T2 (in the age classes between 6 and 18 months old) and T3 (6–29 months) and negatively associated with exposure to T1 (9–36 months). Children’s developmental characteristics, as well as maternal feeding practices and feelings with regard to the introduction of solids, were associated with texture acceptance either directly or indirectly by modulating exposure. Children’s ability to eat with their fingers, gagging frequency, and to a lesser extent, dentition as well as maternal feelings with regard to the introduction of solids were the major factors associated with acceptance. This survey provides a detailed description of the development of food texture acceptance over the complementary feeding period, confirms the importance of exposure to a variety of textures and identifies a number of additional person-related associated factors

Déterminants de la conduite de la diversification alimentaire

National audienc

Patterns and predictors of food texture introduction in French children aged 4–36 months

International audienceThe aims of this study were to describe which and when food textures are offered to children between 4 and 36 months in France and to identify the associated factors. An online cross-sectional survey was designed, including questions about 188 food texture combinations representing three texture levels: purees (T1), soft small pieces (T2) and hard/large pieces and double textures (T3). Mothers indicated which combinations they already offered to their child. A food texture exposure score (TextExp) was calculated for all of the texture levels combined and for each texture level separately. Associations between TextExp and maternal and child characteristics and feeding practices were explored by multiple linear regressions, per age class. Answers from 2999 mothers living in France, mostly educated and primiparous, were analysed. Over the first year, children were mainly exposed to purees. Soft and small pieces were slowly introduced between 6 and 22 months, whereas hard/large pieces were mainly introduced from 13 months onwards. TextExp was positively associated with children's number of teeth and ability to eat alone with their finger or a fork. For almost all age classes, TextExp was higher in children introduced to complementary feeding earlier, lower for children who were offered only commercial baby foods and higher for those who were offered only home-made/non-specific foods during the second year. Our study shows that until 12 months of age the majority of French children were exposed to pieces to a small extent. It provides new insights to further understand the development of texture acceptance during a key period for the development of eating habits

Use of added sugar, salt and fat in the first year in France and associated factors in the ELFE cohort study

National audienceBackground and Aims: To describe added sugar, salt and fat uses and their determinants during complementary feeding (CF) period in infants aged 3 to 10 months. Methods: Data are drawn from the ELFE study (Etude longitudinale Française depuis l'Enfance) which included >18000 infants in 2011. A frequency food questionnaire of consumption of added sugar, salt and fat was monthly completed by the mother from the 3rd to the 10th month (N=10,649). The associations between the use of each added-ingredient and (1) socio-economic characteristics and (2) infant care and feeding practices were studied with two models (the second including the factors of the first) with multivariate regressions. Results: Among the participants, 36.9% added sugar, 30.7% salt and 69% of fat at least "sometimes" at least once during follow-up. Use of added sugar and salt was more common among added fat users than among non-users. Mothers who breastfed for ≥2 months added more often sugar, salt, and fat than non-breastfeeding mothers. CF introduction before 4 months was associated with a more frequent use of added sugar, salt and fat. Mothers who reported health professionals as an information source concerning infant care added less often fat, while those who reported the media as an information source added more often fat. The mean frequency of use of ready-prepared baby food was negatively related to the use of added fat. Conclusion: The use of added sugar, salt and fat is related to feeding and child care practices, independently from the socio-economic characteristics of the household

Frequency of use of added sugar, salt, and fat in infant foods up to 10 months in the nationwide ELFE cohort study: Associated infant feeding and caregiving practices

International audienceThe consumption of sugar, salt, and fat in infancy may influence later health. The objective of this study was to describe the frequency of use of added sugar, salt, and fat during the complementary feeding period and the associated infant caregiving practices. Data were obtained from a monthly questionnaire filled by parents for 10,907 infants from the French Etude Longitudinale Française depuis l’Enfance (ELFE) cohort. A score of frequency of use (SU) for added sugar, salt, and fat (oil, margarine, butter, and/or cream) was calculated from the age at complementary feeding introduction (CFI) to the 10th month. Associations between the SU of each added ingredient with infant feeding and caregiving practices were studied with multivariable linear regressions adjusted for familial characteristics. Only 28% of the parents followed the recommendation of adding fat and simultaneously not adding sugar or salt. Breastfeeding mothers were more prone to add sugar, salt, and fat than non-breastfeeding mothers. CFI before four months was positively associated with the SU of added sugar and salt and negatively associated with the SU of added fat. The use of commercial baby food was negatively related to the SU of added salt and fat. The use of these added ingredients was mainly related to breastfeeding, age at CFI, and use of commercial food, and it was independent of the household socioeconomic characteristics

Utilisation de sucre, sel et matières grasses ajoutés chez les enfants de l'étude ELFE et facteurs associés, entre 3 et 10 mois de vie

National audienceIntroduction et but de l'étude : La conduite de la diversification est encore peu décrite en France. Il est recommandé de ne pas rajouter de sucre ni de sel mais d'ajouter des matières grasses (MG) avant 3 ans. Sucre, sel et MG ont une influence sur la santé à moyen et long terme. Par ailleurs, les choix et préférences alimentaires à l'âge adulte pourraient être influencés par les expositions précoces aux différentes saveurs. Notre objectif est de décrire l'exposition au sucre, sel et matières grasses rajoutés au cours de la période de diversification chez des enfants de 3 à 10 mois, ainsi que leurs déterminants. Matériel et méthodes: Les données utilisées sont issues de l'Etude longitudinale française depuis l'enfance (Elfe), qui a inclus en 2011 plus de 18000 enfants, nés dans un échantillon représentatif de maternités. Un questionnaire portant sur la fréquence de consommation de sucre, sel et matières grasses ajoutés a été rempli par la mère du 3ème au 10ème mois de l'enfant (N=10 649). Etaient considérés comme utilisateurs d'un ingrédient donné les parents qui déclaraient en ajouter au moins « parfois » dans au moins un de ces questionnaires. Pour chaque ingrédient, un 1er modèle a permis d'étudier les associations entre son utilisation et les caractéristiques sociodémographiques des parents et de l'enfant par des régressions multivariées (P<0.01). Les associations entre l'utilisation d'un ingrédient et les pratiques de soins et de nourrissage de l'enfant ont été étudiées à l'aide d'un 2ème modèle incluant les facteurs du 1er modèle. Résultats et Analyse statistique : Parmi les participants, 36.9% ajoutaient du sucre, 30.7% du sel et 69% des MG au moins « parfois » au moins une fois entre 3 et 10 mois. Le suivi longitudinal mensuel montrait une augmentation croissante de l'utilisation de chaque ingrédient, mais qui restait plus faible pour le sel et le sucre par rapport aux MG. Les ajouts de sucre et de sel étaient plus fréquents parmi les utilisateurs de MG ajoutées que parmi les non-utilisateurs de MG ajoutées. Les mères jeunes (<25 ans) ajoutaient plus de sucre et de sel, les foyers aux revenus les plus élevés ajoutaient moins de sucre, alors que ceux aux revenus les faibles ajoutaient plus de sel. Les enfants de second rang de naissance (ou plus) recevaient plus de sucre ou de sel ajouté. Un lieu de naissance hors de France pour au moins un des deux parents était associé à l'ajout de sucre, sel ou MG. Les mères ayant allaité leur enfant au moins 2 mois ont ajouté plus souvent du sucre, sel, et MG que celles n'ayant pas allaité. Les mères qui déclaraient les professionnels de santé comme source d'information ajoutaient moins de MG, celles déclarant les medias comme source d'information ajoutaient plus de MG. Le score moyen d'utilisation d'aliments pour bébé était négativement lié à l'ajout de MG. Conclusion: Les pratiques de nourrissage et de soins à l'enfant ont un lien avec les ingrédients ajoutés au cours de la diversification, indépendamment des facteurs socio-économiques. De futures recherches sur la perception parentale de l'alimentation infantile pourraient permettre d'améliorer la pertinence de l'information

Initiating complementary feeding: a decision influenced by the child's growth?

International audienceBackground and aims: Infant feeding practices are subject to multiple influences. The age of onset of complementary feeding (CF) varies according to many factors such as maternal characteristics (smoking, age, education level, body size, country of birth) or infant characteristics (sex) (Bournez et al., 2017). The aim was to study if, in addition to these factors, age could depend on the child's growth. We have hypothesized that larger children (or heavier / more corpulent ones) would be introduced to CF earlier than "average"-sized children would. Methods: Data from the ELFE cohort (French Longitudinal Study since Childhood) made it possible to describe the age of CF, and to model estimates growth at different ages. We evaluated associations between length, weight, body mass, estimated growth rates at 3 months of age (i.e. before the minimum age of 4 months recommended for CF), and age of CF initiation, using linear regressions adjusted for potential confounders, for 9078 children. Results: Children with a higher weight, a higher length at the age of 3 months and growing the fastest between birth and 3 months were more likely to be introduced to CF earlier, especially before 4 months. It confirms the hypothesis that the decision to initiate CF could be influenced, consciously or not, by the fact that the child grows (in weight and length) rapidly. Conclusions : infants who are heavier, taller, or growing more quickly at 3 months were introduced to CF earlier, before 4 months

Débuter la diversification alimentaire : une décision influencée par la croissance de l'enfant ?

National audienceLes pratiques d'alimentation des nourrissons sont soumises à des influences multiples. Ainsi, l'âge de début de diversification varie selon de nombreux facteurs comme les caractéristiques maternelles (tabagisme, âge, niveau d'études, corpulence, pays de naissance) ou infantiles (sexe) (Bournez et al., 2017). Nous voulions étudier si cet âge pouvait de plus dépendre de la croissance de l'enfant, et traduire ainsi une sensibilité de la mère à cet aspect du développement. Nous avons envisagé que les enfants les plus grands (ou lourds, ou corpulents) pourraient être diversifiés plus tôt que les enfants de taille « moyenne ». Les données de la cohorte ELFE (Etude Longitudinale Française depuis l'Enfance) permettent de décrire l'âge de diversification alimentaire, et de modéliser des estimations de la taille, du poids et des vitesses de croissance à différents âges. Nous avons évalué les associations entre la taille, le poids, la corpulence, les vitesses de croissance estimés à l'âge de 3 mois (i.e. avant l'âge minimal de 4 mois, recommandé pour la diversification en France), et l'âge de début de la diversification alimentaire, à l'aide de régressions linéaires ajustées sur les facteurs de confusion potentiels, pour 9078 enfants. Cette étude montre que les enfants ayant un poids plus élevé, une taille plus élevée à 3 mois et grossissant le plus rapidement entre la naissance et 3 mois ont une plus grande probabilité d'être diversifiés plus tôt, notamment avant 4 mois. Elle confirme l'hypothèse que la décision de diversifier serait influencée, consciemment ou non, par le fait que l'enfant grandisse et grossisse rapidement