This cross-sectional study evaluated the nutritional composition and labelling of commercial foods in Canada targeted to infants up to 18 months of age. Front-of-package labelling requirements were assessed based on daily values identified by Health Canada for saturated fatty acids, sugars, and sodium for children aged one year and older. Infant commercial food products were identified from online and in-person records of retailers across Canada. A total of 1,010 products were identified. Products aimed at older infants (12–18 months) contained significantly more calories, macronutrients, sugars, saturated fat, and trans fat compared to those targeted at younger infants (<12 months). In addition, 40% of products for children aged 12–18 months required a ‘high in sugar’ front-of-package label, while less required a ‘high in saturated fats’ (13%) and ‘high in sodium’ (5%) label. Organic products had higher added sugar and fibre, while they were lower in calories, total fat, saturated fat, and protein. Plant-based products, including vegetarian/vegan products, contained fewer calories, fat, saturated fat, trans fat, and protein, but more fibre. Gluten-containing products had more calories, macronutrients, sugar, fibre, and saturated fat. Non-GMO labelled products had more calories, carbohydrates, and sugar, but less saturated fat. Significant differences were observed for vitamins and minerals across food categories (p < 0.05). Our findings offer valuable guidance for parents, caregivers, and healthcare professionals on infant nutrition, highlighting the importance of selecting foods that align with infants’ specific dietary needs.

This study examines how infant temperament, particularly fear, influences physiological improvements in infants following maternal postpartum depression (PPD) treatment. Forty infants of birthing parents with major depressive disorder and 40 healthy controls were recruited. Parents with PPD participated in a nine-week cognitive-behavioral therapy intervention. Infant emotion regulation was assessed using high-frequency heart-rate variability (HF-HRV) and frontal alpha asymmetry (FAA) at baseline (T1), immediately post-treatment (T2), and three months later (T3). Birthing parents also reported on their infant’s temperamental fear using the Infant Behavior Questionnaire-Revised Short-Form at these times. A significant increase in HF-HRV was observed immediately after treatment in the PPD group which persisted at T3. While no Group × Visit × Fear interaction emerged from repeated measure models, follow-up regression analyses within the PPD group revealed that higher baseline fear was associated with smaller increases in HF-HRV from T1 to T2 or T3. Although FAA shifted leftward over time, fear did not significantly predict FAA changes. No associations between fear and physiology were observed in the control group. The study suggests that infant fear may reduce the physiological benefits of maternal PPD treatment for infants, underscoring the importance of considering infant characteristics when assessing the impact of maternal PPD interventions.

The transition from breastmilk to solid foods (weaning) is a critical stage in infant development and plays a decisive role in the maturation of the complex microbial community inhabiting the human colon. Diet is a major factor shaping the colonic microbiota, which ferments nutrients reaching the colon unabsorbed by the host to produce a variety of microbial metabolites influencing host physiology(1). Therefore, making adequate dietary choices during weaning can positively modulate the colonic microbiota, ultimately contributing to health in infancy and later life(2). However, our understanding of how complementary foods impact the colonic microbiota of weaning infants is limited. To address this knowledge gap, we employed a metagenome-scale modelling approach to simulate the impact of complementary foods, either combined with breastmilk or with breastmilk and other foods, on the production of organic acids by colonic microbes of weaning infants(3). Complementary foods and combinations of foods with the greatest impact on the in silico microbial production of organic acids were identified. These foods and food combinations were further tested in vitro, individually or in combination with infant formula. Fifty-three food samples were digested using a protocol adapted from INFOGEST to mimic infant digestion and then fermented with faecal inoculum from 6 New Zealand infants (5-11 months old). After 24h of fermentation, the production of organic acids was measured by gas chromatography. Differences in organic acid production between samples were determined using the Tukey Honestly Significant Difference test to account for multiple comparisons. The microbial composition was characterised by amplicon sequencing of the V3-V4 regions of the 16S bacterial gene. Taxonomy was assigned using the DADA2 pipeline and the SILVA database (version 138.1). Bioinformatic and statistical analyses were conducted using the R packages phyloseq and ANCOM-BC2, with the Holm-Bonferroni adjustment to account for false discovery rates in differential abundance testing. Blackcurrant and raspberries increased the production of acetate and propionate (Tukey’s test, p<0.05) and the relative abundance of the genus Parabacteroides (Dunnett’s test, adjusted p<0.05) compared to other foods. Raspberries also increased the abundance of the genus Eubacterium (Dunnett’s test, adjusted p<0.05). When combined with infant formula, black beans stood out for increasing the production of butyrate (Tukey’s test, p<0.05) and the relative abundance of the genus Clostridium (Dunnett’s test, adjusted p<0.05). In conclusion, this study provides new evidence on how complementary foods, both individually or in combination with other dietary compounds, influence the colonic microbiota of weaning infants in vitro. Insights generated by this research can help design future clinical trials, ultimately enhancing our understanding of the relationship between human nutrition and colonic microbiota composition and function in post-weaning life.

Poor iron status is one of the most prevalent problems facing infants worldwide, in both developing and developed countries(1). A complex interplay of both dietary and non-dietary factors affects iron intake, absorption, and requirements, and subsequently iron status(2). We aimed to describe iron status in an ethnically diverse cohort of urban-dwelling infants. Data were collected from 364 infants aged 7.0 to 10.0 months living in two main urban centres in New Zealand (Auckland and Dunedin) between July 2020 and February 2022. Participants were grouped by total ethnicity, with any participants who did not identify as either Māori or Pacific categorised into a single ‘others’ group. Haemoglobin, plasma ferritin, soluble transferrin receptor (sTfR), C-Reactive protein, and alpha-1-acid-glycoprotein were obtained from a non-fasting venous blood sample. Inflammation was adjusted for using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) method(3). Body iron concentration (mg/kg body weight) was calculated using the ratio of sTfR and ferritin. A total of 96.3% of Pacific infants were iron sufficient, defined as body iron ≥0 mg/kg body weight and haemoglobin (Hb) ≥105 g/L, compared to 82.3% of Māori and 76.0% of ‘other’ (i.e. neither Māori nor Pacific) infants. ‘Other’ infants had the highest prevalence of iron deficiency overall, with 2.8% categorised with iron-deficiency anaemia (IDA) (body iron <0 mg/kg, haemoglobin <105 g/L), 11.8% with early ‘functional’ iron deficiency (body iron <0 mg/kg, haemoglobin ≥105 g/L), and 9.4% with iron depletion (ferritin <15 µg/L, in the absence of early ‘functional’ iron deficiency and iron deficiency anaemia). For Māori infants, 3.2% and 6.5% had IDA and early ‘functional’ iron deficiency respectively, and 8.1% were iron depleted. One (3.7%) Pacific infant was iron depleted, and the remainder were iron sufficient. Plasma ferritin and body iron concentration were, on average, higher in Pacific compared to non-Pacific infants. These findings give an up-to-date and robust understanding of the iron status of infants by ethnicity, highlighting an unexpected finding that infants who are neither Māori nor Pacific may be at higher risk of poor iron status in NZ.

Breastfeeding is the recommended way to feed infants. However, a safe and nutritious substitute for human milk is needed for infants when breastfeeding is not possible. As infants are a vulnerable population group, infant formula products are regulated by prescriptive provisions for composition and labelling. Any changes to the composition of these products must be established as safe prior to being permitted. As our knowledge of human milk expands, infant formula ingredients are developed to better replicate it. Food Standards Australia New Zealand (FSANZ) has assessed the addition of ingredients for the addition to infant formula products including human identical milk oligosaccharides (HiMOs) isolated using precision fermentation methodology. These ingredients are considered to be nutritive substances as their addition to food is intended to achieve specific nutritional purposes. In accordance with the Ministerial Policy Guidelines, FSANZ must assess both the safety and the health effect of nutritive substances for their use in infant formula. FSANZ risk assessments are undertaken by a multidisciplinary team covering toxicological and nutritional considerations using the best available scientific evidence. FSANZ assessments of the health effects concluded that the use of HiMOs in infant formula products would have a beneficial outcome for infants and align with the equivalent role of these substances in human milk(1,2). The weight of evidence supports health effects through an increase in the abundance of Bifidobacterium spp. in the infant gut microbiota, anti-pathogenic effects, inflammatory suppression and facilitation of appropriate immune responses and antigenic memory. FSANZ safety and technical assessments concluded that there are no public health and safety concerns associated with adding HiMOs to infant formula products(1, 2). The permitted levels are comparable to levels in human milk and are chemically and structurally identical to the naturally occurring forms. Food Standards Australia New Zealand, Canberra, 2606, Australia Based on the available evidence and intended purpose, a number of HiMOs have been permitted for use in infant formula products including 2′- fucosyllactose, lacto-N-neotetraose, difucosyllactose, lacto-N-tetraose, 3'-sialyllactose sodium salt, 6'-sialyllactose sodium salt. Evidence continues to emerge on the beneficial effects of HiMOs on infant health.

The Simulator of the Human Intestinal Microbial Ecosystem (SHIME) system was provided with baby feed for one week to stabilise the microbial community, followed by a 10-day period with baby feed and another 10-day period with adult feed. The study was conducted using sterilised and standardised feed formulations, which model dietary conditions in vitro. Following the transition from baby to adult feed, a significant reduction in the proportion of butyrate in comparison to total SCFA was found after transitioning to adult feed in both the transverse colon and distal colon bioreactors. Our findings suggest that abrupt early-life dietary changes from simple to complex carbohydrates as well as the exclusion of bovine milk proteins can transiently lower the ability of the microbiota to produce butyrate. The lack of additional microbial input leads to a delay or impairment of the adaptation to the modified feed composition. However, given the short treatment duration and sterilised feed composition, these findings should be interpreted within the limitations of this in vitro model. A reduction in butyrate concentration following the transition to adult feed may reflect a temporary shift in microbial metabolic activity rather than a long-term impact on energy extraction efficiency in vivo.

This study aimed to assess the impact of hypertensive disorders of pregnancy on infant neurodevelopment by comparing 6-month and 2-year psychomotor development outcomes of infants exposed to gestational hypertension (GH) or preeclampsia (PE) versus normotensive pregnancy (NTP). Participating infants were children of women enrolled in the Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTPs, GH or PE. 6-month and 2-year Ages and Stages Questionnaires (ASQ-3) scores were categorised as passes or fails according to domain-specific values. For the 2-year Bayley Scales of Infant and Toddler Development (BSID-III) assessment, scores > 2 standard deviations below the mean in a domain were defined as developmental delay. Infants (n = 369, male = 190) exposed to PE (n = 75) versus GH (n = 20) and NTP (n = 274) were more likely to be born small for gestational age and premature. After adjustment, at 2 years, prematurity status was significantly associated with failing any domain of the ASQ-3 (p = 0.015), and maternal tertiary education with increased cognitive scores on the BSID-III (p = 0.013). However, PE and GH exposure were not associated with clinically significant risks of delayed infant neurodevelopment in this study. Larger, multicentre studies are required to further clarify early childhood neurodevelopmental outcomes following hypertensive pregnancies.

Se is particularly necessary in infants because of their rapid physical growth period in addition to being indispensable for neurodevelopment. Severe deficiency can lead to cardiomyopathy, hypothyroidism and faltering growth. However, Se can be toxic at high doses. In the paediatric age group, plasma/serum and erythrocyte Se levels seem to increase with age, except in the first year of life. Understanding the variability in Se status during this period can help to identify infants at risk of deficiency and develop strategies for controlling and preventing its consequences. This review aimed to identify the extent and characteristics of the variability of Se status during the first year of life. A search was conducted across five databases to find articles published until 30 July 2024, with no limitations on the language or date of publication. Articles were screened, data were extracted independently by two reviewers, and any disagreement was resolved by a third reviewer. A total of 22 studies comprising 1288 participants were included in this review, 21 of which assessed plasma/serum Se and 12 assessed erythrocyte Se. In the first 4 months of age, serum/plasma Se decreased, remained stable or increased depending on feeding, with an increase in supplemented formula-fed infants and breastfed infants of supplemented mothers. Erythrocyte Se levels showed a declining trend, except in infants fed supplemented formula or breastfed by supplemented mothers. Variability of serum/plasma and erythrocyte Se levels in the first year was associated with maternal Se intake/supplementation and the Se content of the infant’s diet.

This case is a 4-month-old patient with Kawasaki disease who showed coronary artery lesions after a disease relapse. Following the guidelines from the Randomised Controlled Trial to Assess Immunoglobulin plus Steroid Efficacy, the patient initially saw an improvement in symptoms. However, a relapse occurred despite low levels of C-reactive protein, leading to significant coronary artery growth. Treatment with a third dose of intravenous immunoglobulin and cyclosporine led to a slow reduction in the size of the coronary artery abnormalities. This case highlights the difficulty in monitoring Kawasaki disease progression through clinical symptoms and C-reactive protein levels alone. We also emphasise the necessity of echocardiographic monitoring in patients receiving anti-inflammatory treatments, including steroids, because coronary artery problems can arise or continue without the usual signs of Kawasaki disease or increased C-reactive protein levels.

We report a case of dilated cardiomyopathy-like hypertensive cardiomyopathy (HTN-CM) with polycystic kidney disease without family history when a 3-month-old boy developed bacteraemia secondary to a urinary tract infection. He was later confirmed as having autosomal recessive inheritance due to the proven PKHD1 gene mutation. The treatment consisted mainly of antihypertensive and anti-heart failure therapies and he was discharged on the 131st day. To prevent the development of heart failure in patients with HTN-CM due to autosomal recessive polycystic kidney disease (ARPKD), it is important to improve the fetal diagnosis rate of ARPKD, detect hypertension early, and strictly control the blood pressure after birth.

The complementary feeding period (6-23 months of age) is when solid foods are introduced alongside breastmilk or infant formula and is the most significant dietary change a person will experience. The introduction of complementary foods is important to meet changing nutritional requirements(1). Despite the rising Asian population in New Zealand, and the importance of nutrition during the complementary feeding period, there is currently no research on Asian New Zealand (NZ) infants’ micronutrient intakes from complementary foods. Complementary foods are a more easily modifiable component of the diet than breastmilk or other infant milk intake. This study aimed to compare the dietary intake of micronutrients from complementary foods of Asian infants and non-Asian infants in NZ. This study reported a secondary analysis of the First Foods New Zealand cross-sectional study of infants (aged 7.0-9.9 months) in Dunedin and Auckland. 24-hour recall data were analysed using FoodFiles 10 software with the NZ food composition database FOODfiles 2018, and additional data for commercial complementary foods(2). The multiple source method was used to estimate usual dietary intake. Ethnicity was collected from the main questionnaire of the study, answered by the respondents (the infant’s parent/caregiver). Within the Asian NZ group, three Asian subgroups were identified – South East Asian, East Asian, and South Asian. The non-Asian group included all remaining participants of non-Asian ethnicities. Most nutrient reference values (NRV’s)(3) available for the 7-12 month age group are for total intake from complementary foods and infant milks, so the adequacy for the micronutrient intakes from complementary foods alone could not be determined. Vitamin A was the only micronutrient investigated in this analysis that had an NRV available from complementary foods only, allowing conclusions around adequacy to be made. The Asian NZ group (n = 99) had lower mean group intakes than the non-Asian group (n = 526) for vitamin A (274µg vs. 329µg), and vitamin B12 (0.49µg vs. 0.65µg), and similar intakes for vitamin C (27.8mg vs. 28.5mg), and zinc (1.7mg vs. 1.9mg). Mean group iron intakes were the same for both groups (3.0mg). The AI for vitamin A from complementary foods (244µg) was exceeded by the mean intakes for both groups, suggesting that Vitamin A intakes were adequate. The complementary feeding period is a critical time for obtaining nutrients essential for development and growth. The results from this study indicate that Asian NZ infants have lower intakes of two of the micronutrients of interest than the non-Asian infants in NZ. However, future research is needed with the inclusion of infant milk intake in these groups to understand the total intake of the micronutrients. Vitamin A intakes do appear to be adequate in NZ infants.

Dietary fat is a major energy source and an essential nutrient that supports healthy growth and development in young children(1). Despite the important role of dietary fat in early childhood, our understanding of fat intake trends during this period is limited, particularly among Australian children. Insufficient evidence has led to the establishment of an Adequate Intake (AI) for infants aged 0-12 months in Australia, while no recommendation is available for children ages 1-5 years. This study aimed to comprehensively describe fat intake and major food sources in young Australian children. The data of children at ages 9 months (n = 393), 18 months (n = 284), 3.5 years (n = 244), and 5 years (n = 240) from the Melbourne InFANT Program were used(2). At each time point, child dietary intake data were collected via three 24-hour recalls. Food measurement booklets were utilised to estimate food portions. Food groups and nutrient intakes per day were calculated using the 2007 AUSNUT Food Composition Database. Daily energy (kJ/d) and fat (g/d) intake, the contribution of fat to total energy intake, and key food sources of fat intake were calculated. Descriptive statistics (mean and SD) were used to summarise all data. The mean daily energy intake increased from 3490 kJ/d at 9 months to 5889 kJ/d at 5 years. The mean (SD) fat intake (g/d) was 33.7 (8.0) (Australian AI is 30 g/d) at 9 months, 37.5 (9.5) at 18 months, 44.6 (13.4) at 3.5 years, and 49.0 (15.1) at 5 years. The WHO/FAO recommends that total fat intakes should constitute a minimum of 35% of energy (%E) for children aged 6-24 months, gradually reducing to a range of 25% to 35 %E for children aged 2 to 5 years(3). Notably, 40% of children at 9 months, 76% at 18 months, 14% at 3.5 years, and 12% at 5 years had fat intakes below the WHO/FAO recommendations. In contrast, 24% of children at 3.5 years and 28% at 5 years exceeded the recommendation. At 9 months, the primary source of fat was formula/breastmilk, while at later ages, the major sources were milk/milk products, cakes/cookies, and breads/cereals. The proportion of fat from discretionary foods, such as cakes/cookies, processed meats, butter, oil or fat spreads, increased with age. The percentage of total fat from fish, nuts, and seeds was low, contributing <4 %E at all time points. The study highlights a significant proportion of children exceeding or falling below fat intake recommendations. Moreover, the results suggest low consumption of healthy fat sources such as fish, nuts, and seeds. The study findings will contribute to the refinement of fat recommendations in young Australian children and contribute to interventions that aims to improve fat intakes.

The prevalence of food allergies in New Zealand infants is unknown; however, it is thought to be similar to Australia, where the prevalence is over 10% of 1-year-olds(1). Current New Zealand recommendations for reducing the risk of food allergies are to: offer all infants major food allergens (age appropriate texture) at the start of complementary feeding (around 6 months); ensure major allergens are given to all infants before 1 year; once a major allergen is tolerated, maintain tolerance by regularly (approximately twice a week) offering the allergen food; and continue breastfeeding while introducing complementary foods(2). To our knowledge, there is no research investigating whether parents follow these recommendations. Therefore, this study aimed to explore parental offering of major food allergens to infants during complementary feeding and parental-reported food allergies. The cross-sectional study included 625 parent-infant dyads from the multi-centred (Auckland and Dunedin) First Foods New Zealand study. Infants were 7-10 months of age and participants were recruited in 2020-2022. This secondary analysis included the use of a study questionnaire and 24-hour diet recall data. The questionnaire included determining whether the infant was currently breastfed, whether major food allergens were offered to the infant, whether parents intended to avoid any foods during the first year of life, whether the infant had any known food allergies, and if so, how they were diagnosed. For assessing consumers of major food allergens, 24-hour diet recall data was used (2 days per infant). The questionnaire was used to determine that all major food allergens were offered to 17% of infants aged 9-10 months. On the diet recall days, dairy (94.4%) and wheat (91.2%) were the most common major food allergens consumed. Breastfed infants (n = 414) were more likely to consume sesame than non-breastfed infants (n = 211) (48.8% vs 33.7%, p≤0.001). Overall, 12.6% of infants had a parental-reported food allergy, with egg allergy being the most common (45.6% of the parents who reported a food allergy). A symptomatic response after exposure was the most common diagnostic tool. In conclusion, only 17% of infants were offered all major food allergens by 9-10 months of age. More guidance may be required to ensure current recommendations are followed and that all major food allergens are introduced by 1 year of age. These results provide critical insight into parents’ current practices, which is essential in determining whether more targeted advice regarding allergy prevention and diagnosis is required.