Journal Articles
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Item Household food insecurity and novel complementary feeding methods in New Zealand families.(John Wiley and Sons Ltd, 2024-09-02) Katiforis I; Smith C; Haszard JJ; Styles SE; Leong C; Taylor RW; Conlon CA; Beck KL; von Hurst PR; Te Morenga LA; Daniels L; Brown KJ; Rowan M; Casale M; McLean NH; Cox AM; Jones EA; Bruckner BR; Jupiterwala R; Wei A; Heath A-LMOptimal nutrition during infancy is critical given its influence on lifelong health and wellbeing. Two novel methods of infant complementary feeding, commercial baby food pouch use and baby-led weaning (BLW), are becoming increasingly popular worldwide. Household food insecurity may influence complementary feeding practices adopted by families, but no studies have investigated the use of BLW and baby food pouches in families experiencing food insecurity. The First Foods New Zealand study was a multicentre, observational study in infants 7.0-9.9 months of age. Households (n = 604) were classified into one of three categories of food insecurity (severely food insecure, moderately food insecure, and food secure). The use of complementary feeding practices was assessed via a self-administered questionnaire, both at the current age (mean 8.4 months) and retrospectively at 6 months. Mothers experiencing severe food insecurity had 5.70 times the odds of currently using commercial baby food pouches frequently (≥5 times/week) compared to food secure mothers (95% CI [1.54, 21.01]), reporting that pouches were 'easy to use' (89%) and made it 'easy to get fruits and vegetables in' (64%). In contrast, no evidence of a difference in the prevalence of current BLW was observed among mothers experiencing moderate food insecurity (adjusted OR; 1.28, 95% CI [0.73, 2.24]) or severe food insecurity (adjusted OR; 1.03, 95% CI [0.44, 2.43]) compared to food secure mothers. The high prevalence of frequent commercial baby food pouch use in food insecure households underscores the need for research to determine whether frequent pouch use impacts infant health.Item Parent-reported offering of allergen foods to infants during complementary feeding: An observational study of New Zealand infants(Elsevier Ltd, 2024-12-01) Medemblik JM; Conlon CA; Haszard JJ; Heath A-LM; Taylor RW; Von Hurst P; Beck KL; Te Morenga L; Daniels L; Keller KThe prevalence of food allergies in New Zealand infants is uncertain but is believed to be similar to Australia, exceeding 10%. Current recommendations for reducing food allergy risk are to offer all major food allergens to infants from as early as six months of age (start of complementary feeding), and before 12 months of age. However, little is known regarding parental practices around introducing major food allergens. This study aimed to explore parental offering of major food allergens to infants during complementary feeding, and parent-reported food allergies. The cross-sectional study is a secondary analysis of the multi-centre (Auckland and Dunedin) First Foods New Zealand study of 625 parent-infant dyads. Participants were recruited in 2020-2022 when infants were 7-10 months of age. Questionnaires assessed sociodemographic characteristics, complementary feeding approach, infant pouch use and parental responses to five food allergy questions. All major food allergens had been offered to only 17% of infants by 9-10 months of age. Having offered egg, peanut, tree nuts, sesame, soy and seafood was more commonly associated with using a baby-led complementary feeding approach than a parent-led approach (p < 0.001). Frequent baby food pouch use was associated with a lower likelihood of offering egg and peanut (both p < 0.001). Overall, 12.6% of infants had a reported food allergy, with symptomatic response after exposure being the most common diagnostic tool. Most infants are not offered all major food allergens during early complementary feeding, with some parents actively avoiding major food allergens in the first year of life. These results provide up-to-date knowledge of parental practices, highlighting the need for more targeted advice and strategies to improve parental engagement with allergy prevention and diagnosis.Item Frequent Use of Baby Food Pouches in Infants and Young Children and Associations with Energy Intake and BMI: An Observational Study.(MDPI (Basel, Switzerland), 2024-09-19) McLean NH; Bruckner BR; Heath A-LM; Haszard JJ; Daniels L; Conlon CA; von Hurst PR; Beck KL; Te Morenga LA; Firestone R; McArthur J; Paul R; Cox AM; Jones EA; Katiforis I; Brown KJ; Casale M; Jupiterwala RM; Rowan MM; Wei A; Fangupo LJ; Healey M; Pulu V; Neha T; Taylor RW; Fernandez M-LOBJECTIVE: Most wet commercial infant foods are now sold in squeezable 'pouches'. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children. METHODS: In this observational cross-sectional study of 933 young New Zealand children (6.0 months-3.9 years), pouch use was assessed by a questionnaire ('frequent' use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards. RESULTS: The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Māori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (-580 kJ [-1094, -67]), but infants (115 [-35, 265]) and toddlers (-206 [-789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use. CONCLUSIONS: These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI.Item Vitamin B and One-Carbon Metabolite Profiles Show Divergent Associations with Cardiometabolic Risk Markers but not Cognitive Function in Older New Zealand Adults: A Secondary Analysis of the REACH Study.(Elsevier B.V., 2023-12-07) Gillies NA; Milan AM; Cameron-Smith D; Mumme KD; Conlon CA; von Hurst PR; Haskell-Ramsay CF; Jones B; Roy NC; Coad J; Wall CR; Beck KLBACKGROUND: Vitamin B inadequacies and elevated homocysteine status have been associated with impaired cognitive and cardiometabolic health with aging. There is, however, a scarcity of research investigating integrated profiles of one-carbon (1C) metabolites in this context, including metabolites of interconnected folate, methionine, choline oxidation, and transsulfuration pathways. OBJECTIVES: The study aimed to examine associations between vitamins B and 1C metabolites with cardiometabolic health and cognitive function in healthy older adults, including the interactive effects of Apolipoprotein E-ε4 status. METHODS: Three hundred and thirteen healthy participants (65-74 y, 65% female) were analyzed. Vitamins B were estimated according to dietary intake (4-d food records) and biochemical status (serum folate and vitamin B12). Fasting plasma 1C metabolites were quantified by liquid chromatography with tandem mass spectrometry. Measures of cardiometabolic health included biochemical (lipid panel, blood glucose) and anthropometric markers. Cognitive function was assessed by the Computerized Mental Performance Assessment System (COMPASS) and Montreal Cognitive Assessment (MoCA). Associations were analyzed using multivariate linear (COMPASS, cardiometabolic health) and Poisson (MoCA) regression modeling. RESULTS: Over 90% of participants met dietary recommendations for riboflavin and vitamins B6 and B12, but only 78% of males and 67% of females achieved adequate folate intakes. Higher serum folate and plasma betaine and glycine concentrations were associated with favorable cardiometabolic markers, whereas higher plasma choline and homocysteine concentrations were associated with greater cardiometabolic risk based on body mass index and serum lipids concentration values (P< 0.05). Vitamins B and homocysteine were not associated with cognitive performance in this cohort, though higher glycine concentrations were associated with better global cognitive performance (P = 0.017), episodic memory (P = 0.016), and spatial memory (P = 0.027) scores. Apolipoprotein E-ε4 status did not modify the relationship between vitamins B or 1C metabolites with cognitive function in linear regression analyses. CONCLUSIONS: Vitamin B and 1C metabolite profiles showed divergent associations with cardiometabolic risk markers and limited associations with cognitive performance in this cohort of healthy older adults.Item Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study.(MDPI (Basel, Switzerland), 2024-05-15) McLean NH; Haszard JJ; Daniels L; Taylor RW; Wheeler BJ; Conlon CA; Beck KL; von Hurst PR; Te Morenga LA; McArthur J; Paul R; Katiforis I; Brown KJ; Gash MC; Rowan MM; Casale M; Cox AM; Jones EA; Jupiterwala RM; Bruckner B; Fleming L; Heath A-LM; Chen Y; Tran PV; Felt BTIron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.Item Associations of protein intake, sources and distribution on muscle strength in community-dwelling older adults living in Auckland, New Zealand.(Cambridge University Press, 2023-08-23) Hiol AN; von Hurst PR; Conlon CA; Beck KLProtein intake, sources and distribution impact on muscle protein synthesis and muscle mass in older adults. However, it is less clear whether dietary protein influences muscle strength. Data were obtained from the Researching Eating Activity and Cognitive Health (REACH) study, a cross-sectional study aimed at investigating dietary patterns, cognitive function and metabolic syndrome in older adults aged 65-74 years. Dietary intake was assessed using a 4-d food record and muscle strength using a handgrip strength dynamometer. After adjusting for confounders, in female older adults (n 212), total protein intake (β = 0⋅22, P < 0⋅01); protein from dairy and eggs (β = 0⋅21, P = 0⋅03) and plant food sources (β = 0⋅60, P < 0⋅01); and frequently consuming at least 0⋅4 g/kg BW per meal (β = 0⋅08, P < 0⋅01) were associated with higher BMI-adjusted muscle strength. However, protein from meat and fish intake and the coefficient of variance of protein intake were not related to BMI-muscle strength in female older adults. No statistically significant associations were observed in male participants (n = 113). There may be sex differences when investigating associations between protein intake and muscle strength in older adults. Further research is needed to investigate these sex differences.Item Plasma nervonic acid levels were negatively associated with attention levels in community-living older adults in New Zealand(Springer Nature, 2022-08) de Seymour JV; Beck KL; Conlon CA; Von Hurst PR; Mumme KD; Haskell-Ramsay CF; Jones MBThe global population is aging. Preserving function and independence of our aging population is paramount. A key component to maintaining independence is the preservation of cognitive function. Metabolomics can be used to identify biomarkers of cognition before noticeable deterioration. Our study investigated the plasma metabolome of 332 community-living New Zealanders between 65 and 74 years of age, using gas chromatography-mass spectrometry. Six cognitive domains were assessed. Of the 123 metabolites identified using an in-house mass spectral libraries of standards, nervonic acid had a significant, inverse association with the attention domain (P-value = 1.52E− 4; FDR = 0.019), after adjusting for covariates (apolipoprotein E -ε4 genotype, sex, body fat percentage (standardised by sex), age, education, deprivation index, physical activity, metabolic syndrome, polypharmacy, smoking status, and alcohol intake) and multiple testing. Attention is defined as the ability to concentrate on selected aspects of the environment while ignoring other stimuli. This is the first study to identify nervonic acid as a potential biomarker of attention in older adults. Future research should confirm this association in a longitudinal study.Item Impact of a "vegetables first" approach to complementary feeding on later intake and liking of vegetables in infants: a study protocol for a randomised controlled trial(BioMed Central Ltd, 2021-12) Rapson JP; von Hurst PR; Hetherington MM; Conlon CABACKGROUND: Vegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children. Yet few studies have investigated the impact of a "vegetables first" approach to complementary feeding, especially in New Zealand. The purpose of this randomised control trial is to investigate the effect of starting complementary feeding with vegetables only on infants' later intake and liking of vegetables, compared to those starting with fruit and vegetables. METHODS/DESIGN: One-hundred and twenty mother-infant pairs living in Auckland, New Zealand, will be randomised to receive either vegetables only (intervention) or fruit and vegetables (control) for 28 days, starting from the first day of complementary feeding at around 4-6 months of age. Infants will be presented with a brassica (broccoli), followed by a green leafy vegetable (spinach) and sweet fruit (pear) at 9 months of age. The primary outcome measures of intake of each food will be assessed using a weighed food diary. Secondary outcome measures of overall intake, liking and wanting of vegetables will be assessed using a food frequency questionnaire, liking tool and video coding tool, respectively, at 9, 12, and 24 months of age. Infant growth and iron status will be assessed as part of health screening and monitoring at baseline, post intervention and 9 months of age. Other biological samples to be collected include infant stool samples, vitamin D (mother and infant), iron status (mother), and mothers' diet. DISCUSSION: This randomised, controlled trial will be the first to our knowledge to investigate a "vegetables first" approach to complementary feeding on infants' liking and intake of vegetables in New Zealand. Comparison against standard practice (fruit and vegetables as first foods) should complement other trials underway, such as the Baby's First Bites and Nordic OTIS trial. Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12619000737134 . Registered on 16 May 2019.Item Body composition associations with muscle strength in older adults living in Auckland, New Zealand(PLOS, 2021-05-28) Hiol AN; von Hurst PR; Conlon CA; Mugridge O; Beck KL; Coin ABACKGROUND: Aging is associated with decreases in muscle strength and simultaneous changes in body composition, including decreases in muscle mass, muscle quality and increases in adiposity. METHODS: Adults (n = 369; 236 females) aged 65-74 years living independently were recruited from the cross-sectional Researching Eating Activity and Cognitive Health (REACH) study. Body fat percentage and appendicular skeletal muscle mass (ASM) (sum of lean mass in the arms and legs) were assessed using Dual-energy X-ray Absorptiometry (Hologic, QDR Discovery A). The ASM index was calculated by ASM (kilograms) divided by height (meters) squared. Isometric grip strength was measured using a hand grip strength dynamometer (JAMAR HAND). RESULTS: Linear regression analyses revealed that muscle strength was positively associated with the ASM index (R2 = 0.431, p < 0.001). When exploring associations between muscle strength and muscle mass according to obesity classifications (obesity ≥30% males; ≥40% females), muscle mass was a significant predictor of muscle strength in non-obese participants. However, in participants with obesity, muscle mass was no longer a significant predictor of muscle strength. CONCLUSIONS: Body fat percentage should be considered when measuring associations between muscle mass and muscle strength in older adults.Item Relative Validity and Reproducibility of a Semi-Quantitative Food Frequency Questionnaire for Determining Nutrient Intake in Older Adults in New Zealand: The REACH Study(MDPI (Basel, Switzerland), 2022-02) Yu AD; Mumme KD; Conlon CA; von Hurst PR; Gillies N; Heath A-L; Coad J; Beck KL; Smith GIDietary intake is an important predictor of health and disease outcomes. This cross-sectional study evaluated the relative validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) for assessing energy and nutrient intake in older adults. Dietary data were collected 2018-2019 in Auckland, New Zealand from a convenience sample of community-dwelling adults (65-74 years, n = 294, 37% male) using a 109-item self-administered FFQ at baseline (FFQ1) and four weeks later to assess reproducibility. FFQ1 was compared to a four-day food record to determine relative validity. Agreement between dietary assessment tools was assessed for both raw and energy-adjusted nutrient intakes using paired t-tests, correlation coefficients, weighted kappa statistic, Bland-Altman plots, and linear regression analysis. Energy adjustments moderately improved the relative validity and reproducibility for most nutrients. For energy and energy-adjusted nutrient intakes, the mean correlation coefficients were 0.38 (validity) and 0.65 (reproducibility); the mean weighted kappa statistics were 0.27 (validity) and 0.51 (reproducibility). A significant slope of bias was present in 54% (validity) and 25% (reproducibility) of Bland-Altman plots. The Researching Eating, Activity, and Cognitive Health (REACH) FFQ has acceptable relative validity and good reproducibility for ranking nutrient intakes in older New Zealand adults, but is less suitable for assessing absolute nutrient intakes.