An Investigation of the Diets of Infants Born in Ireland During the First Six Months of Life

Appropriate infant feeding practices play a crucial part in achieving optimal health outcomes. It is well established that the protection, promotion and support of exclusive breastfeeding during the first 6-months of life would decrease the health inequalities experienced by mothers and infants (WHO/UNICEF, 2003c). Optimal weaning practices also have significant implications for infant health, notably in relation to normal development, mineral balance and the development of obesity (Department of Health, 1994). Historically, Ireland has one of the lowest breastfeeding rates in Europe. Furthermore, prior Irish-based research indicates significant deficiencies relating to weaning practices among mothers during the first year of life. The present study was designed to investigate the diets of infants born in Ireland and assess compliance with infant feeding recommendations. This cross-sectional prospective study involved the recruitment of 561 pregnant women during the ante-natal period, with subsequent follow-up of mothers who bore term, healthy, singleton infants, at 6-weeks and 6-months post partum. The final sample that met the study criteria consisted of 401 national and 49 non-national mothers. Detailed information on breastfeeding initiation and prevalence rates among national and non-national mothers was elicited, using specific well-defined breastfeeding definitions. A subsequent analysis was undertaken to comprehensively identify the predictors of breastfeeding initiation and duration among national mothers, as well as the barriers that prevent them from attempting the practice. Data are also presented on the weaning practices of national mothers specifically pertaining to the time of weaning, as well as dietary and snacking patterns. A further in-depth analysis was performed to determine the factors associated with the occurrence of sub-optimal weaning practices. In summary, this study highlights significant deviations from current infant feeding recommendations. Importantly, 47.1% of national and 79.6% of non-national mothers initiated breastfeeding (p=0.000) indicating that little improvement has been achieved in terms of increasing breastfeeding rates over the former decade. Of further concern, high early discontinuation rates were observed among the national, compared with the non-national population of mothers, however, the exclusive breastfeeding rates remained low in both populations. In addition, a high prevalence of negative weaning practices was observed, including the finding that 23% of infants were prematurely weaned onto solids by 12-weeks. Mothers who weaned early were significantly more likely to carry out other sub-optimal feeding practices, suggesting that an overall deficiency in weaning information may exist among these mothers. This study provided a greater understanding of how infants are fed during the first 6-months of life in Ireland, adding to our paediatric knowledge base. To attenuate the health inequalities between lower and higher socio-economic groups in our society, results suggest that increased resources and more effective public health education should be apportioned to improve infants’ diets. As the early years represent a time win which disease prevention may be most effective (Campbell et al., 2008), there should be no delay in developing national strategies that encourage increased compliance with infant feeding recommendations at a population level

Session 1: Public health nutrition Breast-feeding practices in Ireland

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering ‘any’ breast milk to their infants at 6 weeks. Mothers’ positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and ‘any’ breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers’ attitudes and beliefs pertaining to breast-feeding. These results suggest that the ‘cultural’ barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve

Factors Associated with Weaning Practices in Term Infants: a Prospective Observational Study in Ireland.

The WHO (2001) recommends exclusive breast-feeding and delaying the introduction of solid foods to an infant’s diet until 6 months postpartum. However, in many countries, this recommendation is followed by few mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this prospective, observational study aimed to assess compliance with the WHO recommendation and examine weaning practices, including the timing of weaning of infants, and to investigate the factors that predict weaning at #12 weeks. From an initial sample of 539 pregnant women recruited from the Coombe Women and Infants University Hospital, Dublin, 401 eligible mothers were followed up at 6 weeks and 6 months postpartum. Quantitative data were obtained on mothers’ weaning practices using semi-structured questionnaires and a short dietary history of the infant’s usual diet at 6 months. Only one mother (0·2 %) complied with the WHO recommendation to exclusively breastfeed up to 6 months. Ninety-one (22·6 %) infants were prematurely weaned onto solids at #12 weeks with predictive factors after adjustment, including mothers’ antenatal reporting that infants should be weaned onto solids at #12 weeks, formula feeding at 12 weeks and mothers’ reporting of the maternal grandmother as the principal source of advice on infant feeding. Mothers who weaned their infants at #12 weeks were more likely to engage in other sub-optimal weaning practices, including the addition of non-recommended condiments to their infants’ foods. Provision of professional advice and exploring antenatal maternal misperceptions are potential areas for targeted interventions to improve compliance with the recommended weaning practices

The Prevalence and Determinants of Breastfeeding Initiation and Duration in a Sample of Women in Ireland

Objective: To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and ‘any’ breast-feeding at 6 weeks in a sample of Irish-national mothers. Design: This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum. Setting: Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin. Subjects: In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study. Results: Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79?6%, respectively. Factors that were significantly (P50?000) associated with both breast-feeding initiation and ‘any’ breast-feeding at 6 weeks included mothers who were $35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breastfeeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation. Conclusions: Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breastfeeding may prove effective in addressing this cultural barrier

Session 1: Public health nutrition Breast-feeding practices in Ireland

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering ‘any’ breast milk to their infants at 6 weeks. Mothers’ positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and ‘any’ breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers’ attitudes and beliefs pertaining to breast-feeding. These results suggest that the ‘cultural’ barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve

Hijacked then lost in translation:the plight of the recombinant host cell in membrane protein structural biology projects

Membrane protein structural biology is critically dependent upon the supply of high-quality protein. Over the last few years, the value of crystallising biochemically characterised, recombinant targets that incorporate stabilising mutations has been established. Nonetheless, obtaining sufficient yields of many recombinant membrane proteins is still a major challenge. Solutions are now emerging based on an improved understanding of recombinant host cells; as a 'cell factory' each cell is tasked with managing limited resources to simultaneously balance its own growth demands with those imposed by an expression plasmid. This review examines emerging insights into the role of translation and protein folding in defining high-yielding recombinant membrane protein production in a range of host cells

Mothers Who Formula Feed: Their Practices, Support Needs and Factors Influencing Their Infant Feeding Decision.

The majority of mothers in Ireland provide formula milk to their infants during the initial weeks postpartum; however, data are lacking on their formula feeding practices and support needs. This prospective Dublin-based observational study, which included 450 eligible mother-term infant pairs recruited and followed up to 6 months postpartum, aimed to advance our understanding of maternal formula feeding practices, their reasons for deciding to formula feed, sources of feeding information and perceived support needs; insights into infant formula milk consumption patterns in relation to current feeding guidelines are also provided. In summary, the vast majority of infants at 6 weeks were provided with formula milk (n = 368; 81.8%). Positive maternal perceptions of formula feeding were among the most frequently reported reasons underlying mothers’ decision to formula feed (e.g. convenience, 17.3%). Potential public health concerns over the large formula milk volumes consumed by infants (mean 205ml/kilogram/day) relative to infant feeding guidelines (150ml/kilogram/day) were raised from this study. Some mothers continue to add solid foods to infant bottle feeds at 6 weeks (3.8%) and 6 months (6%), a non-recommended feeding practice posing a choking risk for infants. Crucially, this study highlights the need to provide greater support and information to mothers who decide to formula feed postpartum including practical information on sterilisation and formula reconstitution. While breastfeeding promotion and research continues to be a public health priority in Ireland, addressing the support and information needs of mothers who formula feed, an underrepresented and understudied population in the literature, also needs to be considered to ensure optimal health and safety for their infants

Early Formula Feeding Practices and Their Potential Contribution To Later Obesity Risk

Background and Aims: Early feeding practices, including early introduction to solid foods and overfeeding, are known risk factors for childhood obesity. This study aimed to assess maternal formula feeding practices and infant formula feeding patterns, factors that are known to potentially contribute to later obesity risk. Methods: This prospective observational study involved the recruitment and follow-up of 450 eligible mother-infant pairs to 6 weeks postpartum. Data related to formula milk consumption patterns, formula type/brand changing, additions of solid foods to bottle feeds were examined, and available infant weight measurements at 6 weeks recorded. Results: In total, 368 (81.8%) mothers provided any formula milk to their infants at 6 weeks; of these, 14 (3.8%) reported to adding solid foods to their infant’s bottle feeds. Almost 50% of formula feeding mothers (n = 181) reported to changing their infant’s formula type/brand at least once during the first 6 weeks, mainly due to increased hunger and feeding frequency (2-3 hourly) (54.8%). Where 6 week infant weight measurements were available (n = 184), a mean of 205ml (SD 45ml) of formula milk/kilogram body weight/day was consumed by these infants. Conclusion: Several formula feeding practices with potential implications for later obesity risk were identified in this study including premature introduction to solids (≤ 6 weeks) and consumption of excessive formula milk volumes at 6 weeks relative to infant feeding guidelines. Early provision of recommended feeding guidelines including specific advice on age-appropriate milk volumes to parents who formula feed should be considered in obesity prevention programmes

Breastfeeding Practices in Ireland: a Review

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering ‘any’ breast milk to their infants at 6 weeks. Mothers’ positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and ‘any’ breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers’ attitudes and beliefs pertaining to breast-feeding. These results suggest that the ‘cultural’ barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve