Characterising very early diet exposures: development of a complementary feeding index Rebecca K Golley PhD APD Research Fellow Public Health Group Sansom Institute for Health Research University of South Australia, Adelaide

Acknowledgements Lisa G Smithers 2, Murthy N Mittinty 2, Laima Brazionis 2, Pauline Emmett 3, Karen Campbell 4, Sarah McNaughton 4, Kate Northstone 3, John W Lynch 2,3 1 University of South Australia, 2 University of Adelaide, Australia, 3 University of Bristol, England, 4 Deakin University, Australia Funding support: RKG is supported by the National Health and Medical Research Council of Australia.

Why the Complementary Feeding Period? Nutritionally sensitive period –Breastfeeding duration –Age of introduction of solids –Type, amount and composition of food Supply of energy and nutrients Establishment of lifelong dietary behaviours –Food habits –Taste and texture preferences Implications for later diet, health and development

What’s the Challenge? Three studies ‘diet quality’ <12 mo age Smithers et al Nutr Reviews 2011 Nutrient adequacy, Diet diversity Child Feeding Index Complementary feeding guidelines –Sufficient nutritious food for growth, development & health (amount, quality, variety, moderation) –Developmentally appropriate (timing, texture) –‘How’ to feed (responsive feeding, persistence)

Study Aim To development an index to characterise quality of the complementary feeding period –adherence to complementary feeding guidelines –developed country context –address (some) methodological challenges To examine the face validity of the Complementary Feeding Utility Index (CFUI) –Food and nutrient intake –sociodemographic characteristics –Dietary patterns in childhood

Summary of Diet Index Construction Selection of index components Quantification of component scores Summing of component scores TOTAL SCORE ‘Diet quality’ Adapted Kourlaba et al 2009

Breastfeeding durationmonths Fed on demandcategorical Timing introduction complementary foodsmonths Exposure to iron-rich (i.e. fortified) cerealsyes: no Early meat, fish, egg variety0,1,2,3 Frequency of fruit and vegetables exposure (2)times/day Early introduction of teayes: no Exposure to sugary drinks & EDNP foods (2)0-5/6 Early introduction of cow's milkyes: no Timing of introduction of lumpy foodsmonths Homemade: ready-prepared mealsratio Meal routinenumber of meals/day CFUI: 14 components Breastfeeding (months) Energy dense nutrient poor foods (types) Fed on demand (categorical ) N S Y

IndicatorScore Approach Breastfeeding durationMth BF/12 Fed on demandEmpirical Timing introduction complementary foodsTheoretical Exposure to iron-rich (i.e. fortified) cerealsEmpirical Early meat, fish, egg varietyEmpirical Frequent vegetables exposureTheoretical Frequent fruit exposureTheoretical Early introduction of teaEmpirical Degree of exposure to sugary drinksTheoretical Degree of exposure to confectionary, cakes and biscuits, savoury snacks Theoretical Early introduction of cow's milkEmpirical Timing of introduction of lumpy foodsEmpirical Ratio home-: ready-prepared mealsEmpirical Meal routine 6mthsEmpirical Quantification of component scores: Conversion to Probabilities Variety of Protein foods = # children having 1 to 3 types protein foods - # having 1 or 2 or 3 types # children having 1 to 3 types protein foods = # children having 1 type protein foods i.e = 0.51

Quantification of component scores: Theoretical Derived Probabilities

How to derive a total score? Each component has score of 0 to 1 Sum or mean: various pathways=same score Inverse Euclidian norm: how each component score varies from guideline adherence C 1C 2C 3Traditional ScoreCFUI Score P / 3 (mean 0.07)0.06 P / 3 (mean 0.9)0.9 P /3 (mean 0.7)0.5 P /3 (mean 0.7)0.7

N= mo Mean CFUI score = 0.48±0.1

Association with energy-adjusted nutrient intake Nutrient intake at 8 months of age for Children In Focus sub-sample (n=989)

Socio-demographic factors Higher Complementary Feeding Utility Index scores were associated with –older maternal age –higher maternal education level –Healthy maternal weight status. Higher Complementary Feeding Utility Index scores were not associated with –Number of siblings

Association with Dietary Patterns at 3 y Adjusted models; dietary pattern scores, child, maternal and family socio-demographics N=6065

Conclusions The Complementary Feeding Utility Index –reflects adherence to early feeding guidelines –has face validity as a composite measure of early diet quality –scores were associated with food and nutrient intake largely in the expected direction Methodological challenges addressed –components that are unit free –Scoring range based on observed/ theoretical preferences –Contribution of components to total score Next steps –Predictive validity: association with child health and development outcomes

THANK YOU! Questions?