Overreporting of dietary intake in infants is a problem when using food records (FR), distorting possible relationships between diet and health outcomes. Image-assisted dietary assessment may improve the accuracy, but to date, evaluation in the pediatric setting is limited. The aim of the study was to compare macronutrient and energy intake by using an active image-assisted five-day FR against a regular five-day FR, and to validate image-assistance with total energy expenditure (TEE), was measured using doubly labeled water. Participants in this validation study were 22 healthy infants randomly selected from the control group of a larger, randomized intervention trial. The parents reported the infants’ dietary intake, and supplied images of main course meals taken from standardized flat-surfaced plates before and after eating episodes. Energy and nutrient intakes were calculated separately using regular FR and image-assisted FRs. The mean (± standard deviations) energy intake (EI) was 3902 ± 476 kJ/day from the regular FR, and 3905 ± 476 kJ/day from the FR using active image-assistance. The mean EI from main-course meals when image-assistance was used did not differ (1.7 ± 55 kJ, p = 0.89) compared to regular FRs nor did the intake of macronutrients. Compared to TEE, image-assisted FR overestimated EI by 10%. Without validation, commercially available software to aid in the volume estimations, food item identification, and automation of the image processing, image-assisted methods remain a more costly and burdensome alternative to regular FRs in infants. The image-assisted method did, however, identify leftovers better than did regular FR, where such information is usually not readily available.

Background: Inadequate food and water resources negatively affect child health and the efficiency of nutrition interventions. Methods: We used data from the SHINE trial to investigate the associations of food insecurity (FI) and water insecurity (WI) on mothers’ implementation and maintenance of minimum infant dietary diversity (MIDD). We conducted factor analysis to identify and score dimensions of FI (poor access, household shocks, low availability & quality), and WI (poor access, poor quality and low reliability). MIDD implementation (n = 636) was adequate if infants aged 12 months (M12) ate ≥ four food groups. MIDD maintenance (n = 624) was categorized into four mutually exclusive groups: A (unmet MIDD at both M12 and M18), B (unmet MIDD at M12 only), C (unmet MIDD at M18 only), and D (met MIDD at both M12 and M18). We used multivariable-adjusted binary logistic and multinomial regressions to determine likelihood of MIDD implementation, and of belonging to MIDD maintenance groups A-C (poor maintenance groups), compared to group D, respectively. Results: Low food availability & quality were negatively associated with implementation (OR = 0.81; 0.69, 0.97), and maintenance (ORB = 1.29; 1.07, 1.56). Poor water quality was positively associated with implementation (OR = 1.25; 1.08, 1.44), but inconsistently associated with maintenance, with higher odds of infants being in group C (OR = 1.39; 1.08, 1.79), and lower odds of being in group B (OR = 0.80; 0.66, 0.96). Conclusion: Food security should be prioritized for adequate implementation and maintenance of infant diets during complementary feeding. The inconsistent findings with water quality indicate the need for further research on WI and infant feeding.

We have previously shown that diarrheagenic Escherichia coli (DEC) and non-DEC are prevalent in food sources and irrigation water in South Africa. Recent data suggest that an increased relative abundance of faecal Enterobacteriaceae is associated with poorer health outcomes among children in developing countries. Thus, exposure to non-DEC from environmental sources may incur adverse effects, although the mechanisms underlying these effects remain obscure. To further elucidate this phenomenon, we assayed non-DEC strains from environmental sources in South Africa for phenotypes that may be associated with intestinal dysfunction (ID). DEC strains were also used. The strains had previously been isolated from Producer Distributor Bulk Milk (PDBM), irrigated lettuce, street vendor coleslaw and irrigation water.In-vitro assays identified; biofilm formation (n = 38), extracellular polymeric substance (EPS) formation (n = 38), cytotoxic activity (n = 10), disruption of tight junctions and induction of Interleukin 8 (IL-8) on polarized T-84 cells (n = 20). The number of strains tested for each assay differed, depending on prior molecular and phenotypic characterization that signalled potential pathogenicity in-vitro. Subsequently, all strains having data points for all analyses were used to compute Principal Component Analysis (PCA) plot curves to infer potential associations amongst test strains and a standard DEC pathogenic strain (042).Biofilm formation on glass coverslips after strains were grown in nutrient-rich media (LB and DMEM-F12 + 0.5% D-Mannose) at 37 °C varied based on pathotype (DEC and non-DEC) and source of isolation (food, irrigation water, clinical) suggesting that pathotype and source isolation influence persistence within a defined environmental niche. Additionally, DEC isolated from irrigated lettuce had a significantly higher (p ≤ 0.05) propensity for biofilm formation in both media compared to all strains including DEC standard controls. This suggested the propensity for irrigated lettuce as a potential source of persistent pathogenic strains. Furthermore, all strains were able to form EPS suggesting the ability to form mature biofilms under conditions relevant for food processing (20–25 °C). Of the (60%, 6 out of 10) strains that showed cytotoxic activity, most (83%, 5 out of 6 strains) were non-DEC isolated from food sources many of which are consumed with minimal processing.Mean percentage reduction in initial TEER (a measure of intestinal disruption), did not significantly differ (p = 0.05) in all test strains from that observed in the standard DEC. Additionally, IL-8 induction from strains isolated from PDBM (139 pg/mL), irrigation water (231.93 pg/mL) and irrigated lettuce (152.98 pg/mL) was significantly higher (p ≤ 0.05) than in the commensal strain aafa. PCA categorized strains based on sources of isolation showed potential for use in source tracking especially when comparing many strains from various environmental sources. We show that non-DEC strains along the food chain possess characteristics that may lead to ID. Further investigations using a larger collection of strains may provide a clearer link to these reported observations that could be associated with the high diarrheal disease burden within the country, especially among infants.

PURPOSE: The French Nutri-Bébé 2013 study aimed to assess the nutritional intake of infants and young children in comparison with the recommendations of the 2013 European Food Safety Authority (EFSA). METHODS: This cross-sectional study enrolled a random sample of families selected according to the Quota sampling method. A 3-day dietary record was conducted and supervised by two face-to-face interviews. All foods and beverages consumed were qualitatively and quantitatively reported in a diary, and their composition calculated using a food composition database. RESULTS: A total of 1035 non-breastfed children were included. Formula was abandoned early, amounting to approximately 50% of the total food intake at 7 months in 50% of infants and 22% at 1 year. A similar trend was observed for specific complementary foods. After 1 year, 50% of children consumed cow’s milk, which was semi-skimmed in 88% of cases. Drinking water intake was low. Protein intake reached 1.4 times the average requirements before 3 months, 2 times at 8–9 months, and > 4 times at 30–35 months. Fat intake was below the EFSA adequate intake (AI) in > 90% of children. Alpha-linolenic acid intake was equal to or greater than the AI in all infants < 3 months, 85% of children at 6 months, 34% at 12–17 months, and 8% >24 months. Regardless of age, docosahexaenoic acid (DHA) intake was less than the AI. CONCLUSION: Strong discrepancies are observed between the actual and recommended intake in young, non-breastfed children namely, a high-protein intake, and a low fat intake, especially DHA.

Cronobacter species (formerly Enterobacter sakazakii) are emerging opportunistic bacterial pathogens that can infect both infants and adults. This study was conducted to isolate and genotype diverse Cronobacter species from drinking water, chilled fresh pork, powdered infant formula, instant noodles, cookies, fruits, vegetables, and dishes in Northeast China and to evaluate the antibiotic resistance and susceptibility of the isolates. Thirty-four Cronobacter strains were isolated and identified: 21 C. sakazakii isolates (61.8%), 10 C. malonaticus isolates (29.4%), 2 C. dublinensis isolates (5.9%), and 1 C. turicensis isolate (2.9%). These isolates were further divided into 15 sequence types (STs) by multilocus sequence typing. C. sakazakii ST4 (10 isolates, 29.4%), ST1 (3 isolates, 8.8%), and ST8 (3 isolates, 8.8%) and C. malonaticus ST7 (four isolates, 11.8%) were dominant. Antibiotic susceptibility testing indicated that all 34 Cronobacter isolates were susceptible to ampicillin-sulbactam, cefotaxime, ciprofloxacin, gentamicin, meropenem, tetracycline, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole, 88.2% were susceptible to chloramphenicol, and 67.6% were resistant to cephalothin. The results of this study enhance knowledge about genotyping and antibiotic resistance of these Cronobacter species and could be used to prevent potential hazards caused by these strains in drinking water and various food products.

Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1–M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=−0.09; 95% −0.19 to –0.13). From M6 to M18, poor food access was associated with lower LAZ (β=−0.11; 95% −0.20 to –0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory. | PR | 2 Promoting Healthy Diets and Nutrition for all; IFPRI3; CRP4; DCA | PHND; A4NH | CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1–M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=−0.09; 95% −0.19 to –0.13). From M6 to M18, poor food access was associated with lower LAZ (β=−0.11; 95% −0.20 to –0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.

Assessment of risk to infants and children resulting from the ingestion of contaminants in water is an important component of the analysis of possible environmental hazards. Children and infants represent a sensitive life stage because exposure to contaminants in early life can have developmental and long-lasting adverse effects. Children and infants tend to ingest relatively large amounts of water on a bodyweight-adjusted basis, especially those that are fed in early life with formula that is re-constituted or diluted with water. This article presents statistical estimates of the amounts of community water ingested by formula-fed infants based on nationwide sample survey data that support identification of respondents who consume formula and the amounts of water they ingest. Included are specific estimates of the amounts of community water ingested in formula. Estimates of total community water ingestion by children and infants who consume formula can be especially useful in exposure assessment since they represent a highly exposed population. For example, mean community water ingestion by infants 1 to 3 months of age who consume formula is 627 mL/day (136 mL/kg/day) and the 95th percentile is 1096 mL/day (290 mL/kg/day).

To determine whether sociodemographic characteristics, food security status, participation in federal nutrition programs (Supplemental Nutrition Assistance Program [SNAP] or Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), and chronic disease status were associated with adherence to water and sugar-sweetened beverage (SSB) intake recommendations.Cross-sectional, random-digit phone survey with questions from the Behavioral Risk Factor Surveillance System and beverage intake questionnaire.Residents of a medically underserved, rural area.Water and SSB intake.Descriptive statistics, chi-square and 1-way ANOVA, and linear and logistic regression.The sample consisted of 930 respondents (aged 56 ± 17 years; 35% non-white); reported food insecurity and SNAP and WIC participation were 37%, 29%, and 8%, respectively. Prevalent health conditions included overweight/obesity (69%), diabetes (19%), and hypertension (45%). Water recommendations were more likely to be met (72%; mean intake, 31 ± 19 fluid oz) than SSB (41%; mean intake, 246 ± 297 kcal). Food insecurity and SNAP/WIC participation were not associated with meeting recommendations, but those reporting ≥ 1 chronic disease were more likely to meet SSB recommendations (odds ratio, 2.42; P = .02).Odds of achieving SSB but not water recommendations were greater among individuals with a chronic disease. Efforts to communicate beverage recommendations to at-risk groups are needed.