National survey of infant feeding bottles in Germany: Their characteristics and marketing claims.

Bottles and teats are ubiquitously used for feeding infants and young children. Yet there are limited empirical studies on the scope of infant feeding bottles, their attributes, or their marketing claims. We report the first comprehensive survey on infant feeding bottles and teats in Germany. We aimed to explore the extent of bottles and teats available in Germany, describe their physical attributes and analyze their marketing claims. A cross-sectional survey of German bottle and teat manufacturer websites was conducted between June and November 2022. Product attributes are presented with descriptive statistics and photographs. Marketing claims are summarized in a descriptive content analysis. We identified 41 brands encompassing 447 unique products (226 bottles, 221 teats). The majority of bottles were plastic (147, 65%) or glass (64, 28%), and the majority of teats were silicone (188, 85%). Most brands (38, 93%) promoted products using one or more inappropriate marketing claims, including equivalency to breastfeeding (29, 73%), idealization through technical or medical descriptions (23, 58%), claims on disease prevention (31, 78%), references to naturalness (29, 73%), infant autonomy (10, 25%), and endorsements from parents (10, 25%) or health professionals (11, 28%). The majority of bottles and teats available in Germany appear to be marketed inappropriately and hold the potential to undermine public health recommendations on infant and young child feeding. Therefore, we recommend Germany strengthens legislation on the marketing of bottles and teats in accordance with the International Code of Marketing of Breastmilk Substitutes.

Quality of systematic reviews on timing of complementary feeding for early childhood allergy prevention.

BACKGROUND: Only rigorously prepared analyses can provide the highest level of evidence to inform decision-making. Several recent systematic reviews (SRs) examined the hypothesis that the early introduction of specific allergenic complementary foods (CFs) to infants may lead to a lower incidence of one or more allergic outcomes. However, the methodological rigour and quality of reporting of SRs in this area has not yet been systematically evaluated. METHODS: We comprehensively searched PubMed, Medline (Ovid), and Web of Science Core Collection on 13th January 2022, using a pre-specified and tested search syntax for SRs with RCT evidence on the early introduction of allergenic CFs as a means for allergy prevention in infants and children. We examined the quality and risk of bias (RoB) using AMSTAR-2 and ROBIS tools, examined adherence to the Preferred Reporting Items for SRs and Meta-Analyses (PRISMA), and checked whether certainty of the evidence was assessed. RESULTS: Twelve SRs were included. Application of both tools resulted in similar overall judgements in terms of direction and extent for nine of the 12 SRs. Nine SRs were found to be of critically low to low quality according to AMSTAR-2 and to be at high RoB according to ROBIS. One SR received a moderate quality rating (AMSTAR-2) and high RoB rating (ROBIS). However, for two SRs, judgements between AMSTAR-2 and ROBIS were at stark variance. Only two SRs fully adhered to the PRISMA checklist. Six SRs evaluated the certainty of the body of RCT evidence. Several SRs failed to consider unpublished studies either by an explicit a priori exclusion or by inadequate search strategies. CONCLUSIONS: Well-conducted SRs are important for decision-making and informing guideline development, the quality of their methodology should therefore be considered. The methodological rigour and the reporting quality of SRs on the timing of CF for allergy prevention must be improved. REGISTRATION: https://osf.io/7cs4b .

Moving Complementary Feeding Forward: Report on a Workshop of the Federation of International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) and the World Health Organization Regional Office for Europe.

The WHO Regional Office for Europe and the Federation of International Societies for Pediatric Gastroenterology, Hepatology, and Nutrition held a joint workshop, "Moving Complementary Feeding Forward" at the sixth World Congress Pediatric Gastroenterology, Hepatology, and Nutrition in 2021. Here we summarize workshop presentations and discussions. The workshop covered health implications of complementary feeding (CF) including allergies, challenges to meet dietary needs during the CF period, quality of commercial complementary foods (CFD) and respective marketing practices, national CF guidelines in Europe, a nutrient profiling system for CFD, and global policy perspectives on the standards and regulation of marketing for CFD. Adequate CF practices are of critical importance for short and long-term child health, prevention of nutrient deficiencies, normal growth and development, and reducing the risk of allergies. The workshop identified the need to improve feeding practices, harmonize evidence-based information and develop guidance jointly with various stakeholders, improve the composition and marketing practices of commercial CFD and their transparent labeling based on nutrient profiling. Renewed efforts for collaboration between scientists, public health experts, pediatric associations, national governments, and the WHO are necessary for advancing progress.

Supporting breastfeeding of small, sick and preterm neonates.

Breastfeeding is associated with a risk reduction for several acute and chronic diseases in women and their infants. Health benefits of breastfeeding are especially important for small, sick and preterm infants. The objective of this article is to summarize essential steps for healthcare personnel and facilities to improve breastfeeding practices in this vulnerable population. Health facilities can support breastfeeding through the establishment of breastfeeding-supportive policies, staff training and the design of facilities to support rooming-in. Direct support to breastfeeding includes the provision of counseling to mothers at critical time points, skin-to-skin and kangaroo care, and support of responsive (on-demand) breastfeeding. Where direct breastfeeding is not possible, facilities should show mothers how to express their breastmilk and teach mothers alternative feeding modalities. Medically-indicated supplementation of small, sick and preterm may be needed in certain circumstances.

Nutritional Adequacy of Commercial Complementary Cereals in Germany.

Commercial cereals are among the first complementary foods fed to infants in Germany and elsewhere. The purpose of this national survey is to describe the nutritional adequacy of commercial complementary cereals. A comprehensive, cross-sectional survey of cereal manufacturer websites (n = 15) was conducted from March to April 2019. Food labels were analyzed for iron, zinc, iodine, sodium, and sugar contents in commercial complementary cereals, and ingredient lists were evaluated for whole grains and added sugars. Preparation instructions were evaluated for the type of liquid recommended for reconstitution. Among 164 commercial complementary cereals, few contain iron (n = 43, 26%), zinc (n = 23, 14%) or iodine (n = 43, 26%). Sodium contents fall within EU thresholds. Most cereals were single grain, containing only wheat (n = 54), with half of the products (n = 86, 52%) containing whole grains. The average carbohydrate content of dry cereals is 69 g/100 g ± 9 g of which 14 ± 15 g is sugar. Preparation instructions for breakfast porridges and cereals recommend formula or toddler milk, while few recommend human milk (n = 13, 18%). Few commercial complementary cereals contain appreciable amounts (at least 15% of daily reference values) of zinc, iron, or iodine. A quarter of cereal carbohydrates are sugar and one-third of the products contain added sugars. Future directives should stipulate minimum micronutrient levels, strictly regulate sugar contents, and include human milk among preparation instructions.

Commercial complementary food use amongst European infants and children: results from the EU Childhood Obesity Project.

PURPOSE: The objective of this secondary analysis is to describe the types of commercial complementary foods (CCF) consumed by infants and young children enrolled in the European Childhood Obesity Project (CHOP), to describe the contribution of CCF to dietary energy intakes and to determine factors associated with CCF use over the first 2 years of life. METHODS: The CHOP trial is a multicenter intervention trial in Germany, Belgium, Italy, Poland and Spain that tested the effect of varying levels of protein in infant formula on the risk for childhood obesity. Infants were recruited from October 2002 to June 2004. Dietary data on CCF use for this secondary analysis were taken from weighted, 3-day dietary records from 1088 infants at 9 time points over the first 2 years of life. RESULTS: Reported energy intakes from CCF during infancy (4-9 months) was significantly higher (p ≤ 0.002) amongst formula-fed children compared to breastfed children. Sweetened CCF intakes were significantly higher (p ≤ 0.009) amongst formula-fed infants. Female infants were fed significantly less CCF and infant age was strongly associated with daily CCF intakes, peaking at 9 months of age. Infants from families with middle- and high-level of education were fed significantly less quantities of CCF compared to infants with parents with lower education. Sweetened CCF were very common in Spain, Italy and Poland, with over 95% of infants and children fed CCF at 9 and 12 months of age consuming at least one sweetened CCF. At 24 months of age, 68% of the CHOP cohort were still fed CCF. CONCLUSIONS: CCF comprised a substantial part of the diets of this cohort of European infants and young children. The proportion of infants being fed sweetened CCF is concerning. More studies on the quality of commercial complementary foods in Europe are warranted, including market surveys on the saturation of the Western European market with sweetened CCF products.

Food safety considerations for commercial complementary foods from global operational guidance on infant and young child feeding in emergencies.

The use of commercial complementary food (CCF) in humanitarian emergencies is an emerging topic in nutrition policy. Food safety guidance is helpful for the prevention of foodborne illnesses in infants and young children, but whether current global operational guidance on infant and young child feeding in emergencies (IYCF-E) adequately addresses food safety for CCF in humanitarian emergencies is unknown. The aim of this review was to identify and synthesize available food safety guidance on the use of CCF in humanitarian emergencies. A narrative review that included a systematic content analysis and thematic synthesis of global operational guidance on IYCF-E was conducted. Fourteen global guidance documents were selected. Forty-nine excerpts specific to CCF were identified, of which 10 (20%) were rated as relevant to the prevention of foodborne illness. Assessment of inter-rater reliability showed 80% agreement, with a Cohen's kappa coefficient (κ) of 0.52 (moderate agreement). Content was synthesized in 3 themes: donations of CCF, quality assurance and quality control, and water, sanitation, and hygiene principles. Little salient guidance for the safe use of CCF in emergencies was identified. Global operational guidance on IYCF-E should be updated by incorporating food safety considerations for the use of CCF.

Breastfeeding Rates and Programs in Europe: A Survey of 11 National Breastfeeding Committees and Representatives.

INTRODUCTION: Among the world's regions, the WHO European Region has the lowest rates of exclusive breastfeeding at the age of 6 months with approximately 25%. Low rates and early cessation of breastfeeding have important adverse health consequences for women, infants, and young children. Protecting, promoting, and supporting breastfeeding are a public health priority. OBJECTIVES: National breastfeeding data and monitoring systems among selected European countries and the WHO European Region are compared. Mechanisms for the support, protection, and promotion of breastfeeding are reviewed and successes and challenges in implementation of national programs are presented. METHODS: National representatives of national breastfeeding committees and initiatives in 11 European countries, including Belgium, Croatia, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Sweden, and Switzerland, participated in a standardized survey. Results are evaluated and compared in a narrative review. RESULTS: Variation exists in Europe on breastfeeding rates; methodology for data collection; and mechanisms for support, protection, and promotion of breastfeeding. Directly after birth, between 56% and 98% of infants in all countries were reported to receive any human milk, and at 6 months 38% to 71% and 13% to 39% of infants to be breastfed or exclusively breastfed, respectively. National plans addressing breastfeeding promotion, protection, and support exist in 6 of the 11 countries. CONCLUSIONS: National governments should commit to evidence-based breastfeeding monitoring and promotion activities, including financial and political support, to improve breastfeeding rates in the Europe. Renewed efforts for collaboration between countries in Europe, including a sustainable platform for information exchange, are needed.

[Breastfeeding rate and promotion in selected European countries]. / Stillquoten und Stillförderung in ausgewählten Ländern Europas.

BACKGROUND: Breastfeeding benefits the short- and long-term health of mothers and their children. Breastfeeding promotion is an important task for society and the healthcare system. AIMS: We report national breastfeeding data and monitoring systems of selected European countries based on data provided by national breastfeeding committees and international organisations. Strategies for promoting, protecting and supporting breastfeeding, achievements and challenges are reported. METHODS: Representatives of breastfeeding committees and initiatives from Belgium, Croatia, Denmark, Germany, Italy, Ireland, Norway, Sweden, Switzerland, Spain and The Netherlands completed a standardised questionnaire. Reported results were compiled and complemented by additional information compiled by the authors. RESULTS: Considerable differences in breastfeeding rates, data collection and strategies for breastfeeding promotion exist within Europe. At the age of 6 months 35-65% of infants are breastfed and 13-39% are fully or exclusively breastfed in the countries included. Varying methods of breastfeeding monitoring are established in 7 of 11 countries (not in Germany). National breastfeeding committees exist in 9 countries and a national plan for breastfeeding promotion in 6 countries. All country representatives supported stronger European collaboration on improved breastfeeding promotion. CONCLUSIONS: Governments and health systems should collaborate in strengthening evidence based breastfeeding monitoring and promotion and implement financial and policy support. Sustained enhanced collaboration of European countries with exchange of information and experience on breastfeeding support and a new initiative for establishing a strategic European masterplan on breastfeeding promotion appear necessary.

Prevalence of Female Sexual Dysfunction Among Premenopausal Women: A Systematic Review and Meta-Analysis of Observational Studies.

INTRODUCTION: Epidemiologic research in female sexual dysfunction (FSD) has gained momentum in recent years, particularly in clinical populations and in menopausal women. However, sexual dysfunction also affects premenopausal women in general populations. Previous literature reviews have been unable to quantify the burden of FSD in general populations. This has been due in part to different definitions of dysfunction, heterogeneous study design, and the wide variety of measurement tools used. AIM: To provide a meta-analytical estimate of the prevalence of FSD in premenopausal women. METHODS: Observational studies that assessed the prevalence of FSD in premenopausal women were systematically sought in relevant databases (January 2000 through July 2014). Publications that reported the prevalence rate for at least one domain of FSD were included. A meta-analysis of prevalence rates was performed and a meta-regression was used to analyze factors of study design. MAIN OUTCOME MEASURES: Estimated prevalence rates of FSD and its domains (hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, lubrication difficulties, female orgasmic disorder, and pain disorders). RESULTS: After screening 9,292 results, 440 publications were retrieved for full-text review. Of these, 135 studies were included in the systematic review. Ninety-five of these studies were assessed further in a meta-analysis. There was substantial heterogeneity among studies. The prevalence of FSD in premenopausal women was estimated to be 40.9% (95% CI = 37.1-44.7, I2 = 99.0%). Prevalence rates of individual sexual disorders ranged from 20.6% (lubrication difficulties) to 28.2% (hypoactive sexual desire disorder). Further analyses showed significantly higher rates of FSD in studies in Africa, studies that used non-validated assessment tools, and studies without pharmaceutical funding. CONCLUSION: Prevalence estimates of FSD vary substantially. Nonetheless, results show that FSD is a significant public health problem that affects 41% of premenopausal women around the globe. More research and improved standardization are needed in this field.

Prevalence and predictors of female sexual dysfunction: a protocol for a systematic review.

BACKGROUND: Sexual function is an essential component of life. For this reason, sexual dysfunction can have a negative impact on the wellbeing of men and women alike. Since the turn of the 21st century, research on female sexual dysfunction (FSD) has gained momentum. While FSD is often assessed in people with ill health, sexual dysfunction is an illness of its own entity and is also prevalent in non-patient populations. A critical review of current literature on female sexual dysfunction in general populations will shed light on possible determinants as well as at-risk groups. Thus, the aim of this systematic review is to assess the prevalence and the predictors of female sexual dysfunction in general populations. METHODS/DESIGN: A systematic review of current literature on FSD will be performed. Studies will be considered for review if they report quantitative data on the prevalence of female sexual dysfunction. Outcome measures will include the prevalence of FSD, the time period assessed, and significant predictors for each domain of FSD. The scientific databases MEDLINE, EMBASE, PsycINFO, and Web of Science will be systematically searched in cooperation with a medical research librarian. Hand searches for further relevant publications will also be undertaken. Screening of search results and extraction of data from included studies will be conducted cooperatively by two authors. The quality of the studies will be appraised and documented. Results will be compiled and presented in evidence tables. DISCUSSION: In the past decade, population-based studies on female sexual dysfunction have increased in number and grown more varied in their cultural settings. This review aims to provide a current overview of the prevalence of female sexual dysfunction in populations from various countries, cultures, and age groups in order to provide a better understanding of its effect on women's lives today.