Characterising very early diet exposures development of a complementary feeding index
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Characterising very early diet exposures: development of a complementary feeding index. Rebecca K Golley PhD APD. Research Fellow Public Health Group Sansom Institute for Health Research University of South Australia, Adelaide. Acknowledgements.

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Characterising very early diet exposures: development of a complementary feeding index

Rebecca K Golley

PhD APD

Research Fellow

Public Health Group

Sansom Institute for Health Research

University of South Australia, Adelaide


Acknowledgements

Lisa G Smithers2, Murthy N Mittinty2, Laima Brazionis2, Pauline Emmett3, Karen Campbell4, Sarah McNaughton4, Kate Northstone3, John W Lynch2,3

1University of South Australia, 2University of Adelaide, Australia, 3University of Bristol, England, 4Deakin University, Australia

Funding support: RKG is supported by the National Health and Medical Research Council of Australia.


Why the Complementary Feeding Period?

  • Nutritionally sensitive period

    • Breastfeeding duration

    • Age of introduction of solids

    • Type, amount and composition of food

      • Supply of energy and nutrients

  • Establishment of lifelong dietary behaviours

    • Food habits

    • Taste and texture preferences

  • Implications for later diet, health and development


What’s the Challenge?

  • Three studies ‘diet quality’ <12 mo age Smithers et al Nutr Reviews 2011

    • Nutrient adequacy, Diet diversity

    • Child Feeding Index

  • Complementary feeding guidelines

    • Sufficient nutritious food for growth, development & health (amount, quality, variety, moderation)

    • Developmentally appropriate (timing, texture)

    • ‘How’ to feed (responsive feeding, persistence)


  • Study Aim

    • To development an index to characterise quality of the complementary feeding period

      • adherence to complementary feeding guidelines

      • developed country context

      • address (some) methodological challenges

    • To examine the face validity of the Complementary Feeding Utility Index (CFUI)

      • Food and nutrient intake

      • sociodemographic characteristics

      • Dietary patterns in childhood


    Summary of Diet Index Construction

    Selection of index components

    Quantification of component scores

    Summing of component scores

    Adapted Kourlabaet al 2009

    TOTAL SCORE ‘Diet quality’


    CFUI: 14 components

    Breastfeeding (months)

    0 1 2 3 4 5 6 7 8 9 10 11 12

    0 5 10

    Energy dense nutrient poor foods (types)

    0 1 2 3 4 5 6

    0 5 10

    Fed on demand (categorical )

    N S Y

    0 5 10


    Quantification of component scores: Conversion to Probabilities

    Variety of Protein foods

    = # children having 1 to 3 types protein foods - # having 1 or 2 or 3 types

    # children having 1 to 3 types protein foods

    = 9747 - # children having 1 type protein foods i.e. 4735

    9747

    = 0.51


    Quantification of component scores: Theoretical Derived Probabilities


    How to derive a total score?

    • Each component has score of 0 to 1

    • Sum or mean: various pathways=same score

    • Inverse Euclidian norm: how each component score varies from guideline adherence


    Mean CFUI score = 0.48±0.1

    N=6065

    6 mo


    Association with energy-adjusted nutrient intake

    Nutrient intake at 8 months of age for Children In Focus sub-sample (n=989)


    Socio-demographic factors

    • Higher Complementary Feeding Utility Index scores were associated with

      • older maternal age

      • higher maternal education level

      • Healthy maternal weight status.

    • Higher Complementary Feeding Utility Index scores were not associated with

      • Number of siblings


    Association with Dietary Patterns at 3 y

    N=6065

    Adjusted models; dietary pattern scores, child, maternal and family socio-demographics


    Conclusions

    • The Complementary Feeding Utility Index

      • reflects adherence to early feeding guidelines

      • has face validity as a composite measure of early diet quality

      • scores were associated with food and nutrient intake largely in the expected direction

    • Methodological challenges addressed

      • components that are unit free

      • Scoring range based on observed/ theoretical preferences

      • Contribution of components to total score

    • Next steps

      • Predictive validity: association with child health and development outcomes


    Questions?

    Thank you!


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