Maternal dietary intervention during lactation impacts the maternal faecal and human milk microbiota.

AIMS: To determine the effect of a two-week reduced fat and sugar and increased fibre maternal dietary intervention on the maternal faecal and human milk (HM) microbiomes. METHODS AND RESULTS: Faecal swabs and HM samples were collected from mothers (n = 11) immediately pre-intervention, immediately post-intervention, and 4 and 8 weeks post-intervention, and were analysed using full-length 16S rRNA gene sequencing. Maternal macronutrient intake was assessed at baseline and during the intervention. Maternal fat and sugar intake during the intervention were significantly lower than pre-intervention (P = <0.001, 0.005, respectively). Significant changes in the bacterial composition of maternal faeces were detected after the dietary intervention, with decreases in the relative abundance of Bacteroides caccae (P = <0.001) and increases in the relative abundance of Faecalibacillus intestinalis (P = 0.006). In HM, the diet resulted in a significant increase in Cutibacterium acnes (P = 0.001) and a decrease in Haemophilus parainfluenzae (P = <0.001). The effect of the diet continued after the intervention, with faecal swabs and HM samples taken 4 and 8 weeks after the diet showing significant differences compared to baseline. CONCLUSION: This pilot study demonstrates that short-term changes in maternal diet during lactation can alter the bacterial composition of the maternal faeces and HM.

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow's milk allergy.

Cow's milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow's milk allergy, it is critical to examine the evidence for and against any form of cow's milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow's milk proteins detectable in human milk cause infant cow's milk allergy symptoms. Current clinical practice recommendations advise a 2-4 week trial of maternal cow's milk dietary elimination for: a) IgE-mediated cow's milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow's milk allergy; and c) infants with moderate to severe eczema/atopic dermatitis, unresponsive to topical steroids and sensitized to cow's milk protein. There should be a clear plan for home reintroduction of cow's milk into the maternal diet for a period of 1 week to determine that the cow's milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow's milk reintroduction. The evidence base to support the use of maternal cow's milk avoidance for the treatment of a breastfed infant with cow's milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow's milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow's milk allergy maternal cow's milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essential.

Making a SmartStart for peanut introduction to support food allergy prevention guidelines for infants.

Background: Food allergy affects up to 10% of Australian infants. It was hypothesized that if parents follow the Australasian Society of Clinical Immunology and Allergy guidelines, Australian food allergy rates may stabilize or decline. Objective: This project aimed to determine whether SmartStartAllergy influenced parental introduction of peanut by age 12 months, including in high-risk infants. Methods: SmartStartAllergy integrates with general practice management software to send text messages to parents via participating general practices. The intervention group participants were sent text messages when their child was aged 6, 9, and 12 months; the control group participants were parents of 12-month-old infants. When their child was aged 12 months, all participants completed a questionnaire regarding eczema and family history of atopy. Infants with severe eczema and/or a family history of atopy were considered high-risk. Results: Between 21 September 2018 and 26 April 2022, a total of 29,092 parents were enrolled in SmartStartAllergy as intervention (n = 18,090) and control (n = 11,002) group members The intervention group was more likely to introduce peanut by 12 months (crude odds ratio = 5.18; P < .0001; 95% CI = 4.35-6.16). After adjustment for the infants' level of risk and family history of atopy and food allergy, the intervention group was more likely to introduce peanut by 12 months of age (adjusted odds ratio = 5.34; P < .01; 95% CI = 4.48-6.37). Conclusion: SmartStartAllergy appears to be an effective tool for encouraging parental introduction of peanut. The ability to provide parents with credible allergy prevention information, along with the capacity to collect simple responses via text along with additional information via an online questionnaire, make this a useful public health tool.

Iron-Fortified Foods Are Needed To Meet the Estimated Average Requirement for Iron in Australian Infants Aged 6 to 12 Months.

BACKGROUND: Meeting iron intake recommendations is challenging for infants 6-12 mo, especially breastfed infants. Three-quarters of Australian infants 6-12 mo have iron intakes below the estimated average requirement (7 mg), placing them at risk of iron deficiency. After 6 mo, breastmilk is no longer sufficient to meet the increased demand for iron, and iron-rich complementary foods are recommended. Iron-fortified foods may be a means of improving iron intake in infants, particularly those that are breastfed. OBJECTIVES: The aims of the study were as follows: 1) to examine the effect of milk-type and fortified foods on iron intake and the prevalence of inadequacy in infants 6-12 mo; 2) to model the effect of fixed amounts of iron-fortified infant cereal (IFIC) at 6 levels of iron fortification on total iron intake and the prevalence of inadequacy; and 3) to assess the effect IFIC on the intake of other nutrients in the diet. DESIGN: Secondary analysis of cross-sectional dietary intake data of infants 6-12 mo (n = 286) participating in the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. RESULTS: Median (interquartile range) iron intake was 8.9 (7.5, 10.3); 6.3 (4.5, 8.2); and 2.7 (1.5, 4.4) mg/d in formula-fed, combination-fed, and breastfed infants, respectively. The corresponding prevalence of inadequacy was 19%, 67%, and 96%. Infants who consumed fortified foods had higher median iron intakes than those who did not, 6.2 compared with 1.9 mg/d. Dietary modeling showed that consuming 18 g (300 kJ) of IFIC, fortified at 35 mg/100 g dry weight, reduces the prevalence of inadequacy for iron from 75% to 5% for all infants. CONCLUSIONS: Iron intakes are low in Australian infants, especially for breastfed infants in the second half of infancy. Modeling shows that 300 kJ of IFIC, the current manufacturer-recommended serving, fortified at 35 mg/100 g dry weight, added to infant diets would be an effective means to reduce the prevalence of inadequacy for iron.

Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials.

BACKGROUND: Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. BODY: We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. CONCLUSION: We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.

The role of online symptom questionnaires to support the diagnosis of cow's milk allergy in children for healthcare professionals - A Delphi consensus study.

BACKGROUND: Cow's milk allergy (CMA) is one of the most common food allergies world-wide. The emergence of online CMA symptom questionnaires, aimed at parents and/or healthcare professionals (HCP), may raise awareness about the possible diagnosis of CMA, but also increases the risk for overdiagnosis leading to unnecessary dietary restriction impacting on growth and nutrition. This publication sets out to establish the availability of these CMA symptom questionnaires and critically assesses the development and validity. METHODS: Thirteen HCP working in the field of CMA, from different countries, were recruited to participate. A combination of a Pubmed and CINAHL literature and online review using the Google search engine in English language was used. Symptoms in the questionnaires were assessed, using the European Academy for Allergy and Clinical Immunology guidelines for food allergy. Following the assessment of both the questionnaires and literature, the authors followed the modified Delphi approach to generate consensus statements. RESULTS: Six hundred and fifty-one publications were identified, of which 29 were suitable for inclusion, with 26 being associated with the Cow's Milk-Related Symptoms Score. The online search yielded 10 available questionnaires: 7/10 were sponsored by formula milk companies and 7/10 were aimed at parents and three at HCP. Following the assessment of data, 19 statements were generated in two rounds of anonymous voting reaching 100% agreement. CONCLUSIONS: Online CMA questionnaires, available to parents and HCP's, are varied in symptoms, and most were not validated. The overarching consensus generated from authors is that these questionnaires should not be used without the involvement of HCP.

Correction: Moumin et al. Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. Nutrients 2022, 14, 1381.

The authors would like to correct an error in their recently published paper [...].

The immune-supportive diet in allergy management: A narrative review and proposal.

The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune-supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses the existing evidence for a relationship between nutrition, immune function, and allergic disease from a clinical perspective. In addition, the authors propose an immune-supportive diet to enhance dietary interventions and complementing other therapeutic options for allergic disease from early life to adulthood. A narrative review of the literature was conducted, to determine the evidence of the relationship between nutrition and immune function, overall health, epithelial barrier function, and gut microbiome, particularly in relation to allergy. Studies on food supplements were excluded. The evidence was assessed and utilized to develop a sustainable immune-supportive diet to complement other therapies in allergic disease. The proposed diet consists of a highly diverse range of fresh, whole, and minimally processed plant-based and fermented foods supplemented with moderate amounts of nuts, omega-3-rich foods and animal-based products in proportional amounts of the EAT-Lancet diet, such as (fatty) fish, (fermented) milk products which may be full-fat and eggs, lean meat or poultry, which may be free-range or organic.

Impact of public health interventions for food allergy prevention on rates of infant anaphylaxis.

BACKGROUND: Eleven percent of Australian infants have confirmed food allergy. We hypothesized earlier introduction may lead to higher rates of infant anaphylaxis, irrespective of whether the overall rate of food allergy in the population was ultimately reduced. OBJECTIVE: To determine whether a public health campaign, targeting earlier introduction of allergenic foods, affected rates of infant anaphylaxis. METHODS: Data were obtained from St John Ambulance (SJA) Western Australia and Western Australian emergency departments (ED) on infant (≤12 months) anaphylaxis over a 5-year period (July 1, 2015 to June 30, 2020). Adrenaline administration data were collected in the SJA dataset. Poisson regression was undertaken to assess trends in anaphylaxis over time. Segmented regression analysis was undertaken to assess differences in anaphylaxis rates before and after intervention. RESULTS: The SJA and ED datasets included 172 and 294 events, respectively, coded as infant anaphylaxis. Rates of infant anaphylaxis increased over time for both SJA and ED datasets, with a 1-year increase rate ratio of 1.21 (95% confidence interval, 1.09-1.35; P value < .01) and 1.11 (95% confidence interval, 1.02-1.20; P = .01), respectively. Segmented regression indicated no significant difference in rates after intervention. Adrenaline was not coded as being administered in 109 of the 172 anaphylaxis events. CONCLUSION: Rates of infant anaphylaxis increased over the 5-year reporting period; however, there was no clear increase related to the timing of the public health campaign implementation. Reported adrenaline use was suboptimal. Assessing rates of food allergy in all age groups is required to determine whether there has been an overall reduction in food allergy owing to the intervention.

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Highlights and Future Directions.

The 2021 Australian Feeding Infants and Toddlers Study (OzFITS 2021) is the first nationwide survey of the feeding practices of children under 2 years. Key Findings: Nearly half of the infants were exclusively breastfed to 4 months, and breastfeeding duration was long, with 68% of infants breastfed to 6 months and 44% breastfed into their second year. Infants were introduced to complementary foods at the appropriate time, between 4 and 6 months. We found a mismatch between the number of recommended servings from each food group in the Australian Dietary Guidelines and the dietary intake of toddlers in our study. Toddlers consumed twice as many fruit servings as recommended, and nearly all consumed discretionary foods despite no allowance for these foods. While most toddlers consumed the recommended dairy serves, they consumed half the recommended servings for other food groups-meats and alternatives, grains, and vegetables. The modeling that informed the Australian Dietary Guidelines did not include an allowance for breastmilk; this needs to be addressed, as a quarter of toddlers in OzFITS 2021 received 30% or more energy from breastmilk. Infants and toddlers met their requirements for most nutrients. One exception was iron, where 90% of older infants and 25% of toddlers had inadequate intakes. Excessive sodium intake was also of concern, with 1 in 3 toddlers exceeding the upper limit of 1000 mg/day. Here, we discuss additional findings, study limitations, gaps in the evidence base, and future directions.

Effect of a reduced fat and sugar maternal dietary intervention during lactation on the infant gut microbiome.

Objective: A growing body of literature has shown that maternal diet during pregnancy is associated with infant gut bacterial composition. However, whether maternal diet during lactation affects the exclusively breastfed infant gut microbiome remains understudied. This study sets out to determine whether a two-week of a reduced fat and sugar maternal dietary intervention during lactation is associated with changes in the infant gut microbiome composition and function. Design: Stool samples were collected from four female and six male (n = 10) infants immediately before and after the intervention. Maternal baseline diet from healthy mothers aged 22-37 was assessed using 24-h dietary recall. During the 2-week dietary intervention, mothers were provided with meals and their dietary intake was calculated using FoodWorks 10 Software. Shotgun metagenomic sequencing was used to characterize the infant gut microbiome composition and function. Results: In all but one participant, maternal fat and sugar intake during the intervention were significantly lower than at baseline. The functional capacity of the infant gut microbiome was significantly altered by the intervention, with increased levels of genes associated with 28 bacterial metabolic pathways involved in biosynthesis of vitamins (p = 0.003), amino acids (p = 0.005), carbohydrates (p = 0.01), and fatty acids and lipids (p = 0.01). Although the dietary intervention did not affect the bacterial composition of the infant gut microbiome, relative difference in maternal fiber intake was positively associated with increased abundance of genes involved in biosynthesis of storage compounds (p = 0.016), such as cyanophycin. Relative difference in maternal protein intake was negatively associated with Veillonella parvula (p = 0.006), while positively associated with Klebsiella michiganensis (p = 0.047). Relative difference in maternal sugar intake was positively associated with Lactobacillus paracasei (p = 0.022). Relative difference in maternal fat intake was positively associated with genes involved in the biosynthesis of storage compounds (p = 0.015), fatty acid and lipid (p = 0.039), and metabolic regulator (p = 0.038) metabolic pathways. Conclusion: This pilot study demonstrates that a short-term maternal dietary intervention during lactation can significantly alter the functional potential, but not bacterial taxonomy, of the breastfed infant gut microbiome. While the overall diet itself was not able to change the composition of the infant gut microbiome, changes in intakes of maternal protein and sugar during lactation were correlated with changes in the relative abundances of certain bacterial species.Clinical trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12619000606189).

Estimated Choline Intakes and Dietary Sources of Choline in Pregnant Australian Women.

(1) Background: Despite the postulated importance of choline during pregnancy, little is known about the choline intake of Australians during pregnancy. In this study, we estimated dietary intakes of choline in early and late pregnancy, compared those intakes to recommendations, and investigated food sources of choline in a group of pregnant women in Australia. (2) Methods: 103 pregnant women enrolled in a randomized controlled trial. In early pregnancy (12−16 weeks gestation) and late pregnancy (36 weeks gestation), women completed a food frequency questionnaire designed to assess dietary intake over the previous month. (3) Results: Choline intakes and sources were similar in early and late pregnancy. Median choline intake in early pregnancy was 362 mg/day. Of the women, 39% and 25% had choline intakes above the Australian National Health and Medical Research Council (NHMRC) adequate intake (AI) of >440 mg/day and the European Food Safety Authority (EFSA) AI of >480 mg/day for choline in pregnancy, respectively. Eggs, red meat, nuts, legumes, and dairy accounted for 50% of choline intake, with eggs being the most significant contributor at 17%. (4) Conclusions: Few pregnant women in our study met the AI recommended by the NHMRC and EFSA. In Australia, choline intake in pregnancy may need to be improved, but further work to define choline requirements in pregnancy is required.

Does Food Intake of Australian Toddlers 12-24 Months Align with Recommendations: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Food-based dietary guidelines promote population health and well-being through dietary patterns that reduce chronic disease risk while providing adequate energy and nutrients. In Australia, recommended dietary patterns based on servings per day from the five food groups-fruits, vegetables, cereals and grains, meats and alternatives, and dairy-have been developed for toddlers 1-2 years of age. However, no study has assessed the intake of the five food groups in this age group nationally. (2) Aim: To compare daily servings and the percentage of energy from the five food groups and discretionary foods in toddlers 1-2 years old to the Australian Dietary Guidelines. (3) Methods: Dietary intake was assessed using a one-day food record for 475 toddlers. (4) Results: Apart from fruit and dairy, servings of the five food groups were below the recommendations. Two-thirds of toddlers did not consume enough vegetables, and only 10% consumed the recommended number of servings for cereals and grains. On average, toddlers consumed only half the recommended servings of meat and alternatives. Nearly all toddlers (89%) consumed discretionary foods, which accounted for ~12% of total energy. Forty-five percent of toddlers received breastmilk. On average, breastfed toddlers consumed fewer servings from the five food groups than non-breastfed toddlers. Dairy contributed 20% of daily energy in all toddlers; however, this food group accounted for 13% in breastfed and 32% in non-breastfed toddlers on the day of the food record. (4) Conclusions: Compared to the recommendations, alignment with the servings of the five food group foods was not achieved by most toddlers, except for fruit and dairy. Discretionary foods may have displaced nutritious family foods. Consistent with Australian Infant Feeding Guidelines, many toddlers in this study continued to receive breastmilk but the recommended dietary patterns do not include breastmilk. Dietary modeling, including breastmilk as the primary milk source, is urgently needed, along with practical advice on incorporating breastmilk in a toddler's diet while optimizing food consumption.

PrEggNut Study: protocol for a randomised controlled trial investigating the effect of a maternal diet rich in eggs and peanuts from <23 weeks' gestation during pregnancy to 4 months' lactation on infant IgE-mediated egg and peanut allergy outcomes.

INTRODUCTION: Clinical studies supported by immunological data indicate early life intervention strategies to be promising in reducing the growing global burden of food allergies. The events that predispose to food allergy, including the induction of allergen-specific immune responses, appear to be initiated early in development. Early exposure to food allergens in utero and via breast milk is likely to be important in initiating oral tolerance. We aim to determine the effectiveness of higher maternal food allergen consumption during pregnancy and lactation on infant food allergy outcomes. METHODS AND ANALYSIS: This is a multisite, parallel, two-arm (1:1 allocation), single-blinded (outcome assessors, statistical analyst and investigators), randomised controlled trial. Pregnant women (<23 weeks' gestation) whose (unborn) infants have at least two biological family members (mother, father or siblings) with medically diagnosed allergic disease are eligible to participate. After obtaining written informed consent, pregnant women are randomised to either a high egg and peanut diet (at least 6 eggs and 60 peanuts per week) or standard (low) egg and peanut diet (no more than 3 eggs and 30 peanuts per week). The women are asked to follow their allocated diet from <23 weeks' gestation to 4 months' lactation. The primary outcome is food challenge proven IgE-mediated egg and/or peanut allergy in the infants at 12 months of age. Key secondary outcomes include infant sensitisation to egg and/or peanut and infant eczema. Our target sample size is 2136 women. Analyses will be performed on an intention-to-treat basis according to a pre-specified statistical analysis plan. ETHICS AND DISSEMINATION: Ethical approval has been granted from the Women's and Children's Health Network Human Research Ethics Committee (approval number HREC/18/WCHN/42). Trial results will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry ACTRN12618000937213.

Nip allergies in the Bub: a qualitative study for a public health approach to infant feeding for allergy prevention.

OBJECTIVE: To identify a brand, key messages and resources to underpin a public health approach to food allergy prevention. METHODS: A focus group design was used to explore perceptions and opinions of potential brands, infant feeding messages and resources for providing standardised food allergy prevention information. Focus groups were conducted in February 2018 using interview guides and were transcribed verbatim. A content analysis of the transcripts was undertaken using thematic analysis software. The University of Western Australia provided ethics approval: RA/4/20/4280. RESULTS: Seven focus groups with 39 participants were conducted. Four slogans and styles of imagery were considered. 'Nip Allergies in the Bub' was the most favoured slogan and images of babies with food were most favoured. Participant feedback was sought regarding messages and supporting messages were considered important. Participants were consulted about useful resources and a website was identified. CONCLUSIONS: Conducting focus groups assisted the selection of a brand, messages and resources to underpin a public health approach to implementing allergy prevention guidelines. IMPLICATIONS FOR PUBLIC HEALTH: This is the first focus group research undertaken for food allergy prevention. Identification of a meaningful brand, key messages and resources will support a public health approach to implementing allergy prevention guidelines.

An International First: Stakeholder Consensus Statement for Food Allergen Management in Packaged Foods and Food Service for Australia and New Zealand.

Food-allergic consumers encounter inadequate, confusing, and ambiguous allergen information for packaged and unpackaged foods. Key Australian and New Zealand allergy organizations convened multiple forums to facilitate discussions among consumers, food manufacturers, food retailers, regulatory bodies, researchers, and health professionals to develop a unified approach to improving food allergen management. The following stakeholder consensus statement provides a foundation for advocacy for improved food allergen management and safety. It is the responsibility of consumers to: 1. declare their food allergies and read food labels (including ingredient lists and allergen declaration statements), and 2. ultimately make their own judgment about the foods they choose to consume. We consider that to enable consumers to make informed decisions about their safety, It is the responsibility of packaged food manufacturers to: 1. follow robust allergen management practices including quantitative risk assessment, and 2. use clear, consistent labeling to inform consumers about that food's allergen content, including the possible presence of unintended allergens. It is the responsibility of food service establishments and providers to: 1. follow robust allergen management practices, and 2. ensure that staff understand and can inform consumers about the allergen content of the food they provide, including the possible presence of unintended allergens.

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Breastmilk provides all the nutrition an infant requires between 0−6 months. After that, complementary foods are needed to meet the child's increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6− 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children's intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6−11.9 months. Low iron intake was also observed in one quarter of toddlers 12−24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6−11.9 months and toddlers 12−24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.

The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices.

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers' infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital.