UPDATE ON COMPLEMENTARY FEEDING ISSUES Yoga Devaera – FKUI RSCM RSUI DISCLOSURE • I have received research grant from Sari Husada Indonesia • I acknowledge that today’s activity is certified for CME credit and thus cannot be promotional. I will give a balanced presentation using the best available evidence to support my conclusions and recommendations. Outlines INTRODUCTION WHAT’S KNOWN AND WHAT’S NEW SUMMARY INTRODUCTION What does it mean to be human? Brain energy consumption Effects of Brain Evolution on Human Nutrition and Metabolism. Annu. Rev. Nutr. 2007. 27:311–27 L eona rdW, Snodgra ss J, Robertson M. (2011). Diet andBra in Evolu tion: Nutritio na l Implicationsof L arge Human Brain Size. 10.1007/978-0-387-92271-3_1. Brain glucose uptake • PET and MRI data of brain glucose uptake to the body’s resting metabolic rate (RMR) and daily energy requirements (DER) expressed in glucose-gram equivalents (glucosermr% and glucoseder%) • Rate of glucose uptake by the human brain peaks in childhood, when synaptic densities and related metabolic processes are maximal. Kuzawa CW, et al. Proceedings of the National Academy of Sciences Aug 2014, 201323099 Nutrients 2019, 11, 2029 BRAIN DEVELOPMENT IS A METABOLICALLY EXPENSIVE PROCESS WHAT’S ALREADY KNOWN? WHAT’RE THE NEW EVIDENCE? Timing Nonbreastfed Type of food associated with higher adiposity measurements: • Infant cereal • Fruit juice Preterm ◦ No specific timing which applies safely to all preterm infants ◦ Individualized evaluation mainly based on infants’ development rather than corrected or postnatal age. ◦ Preterm infants who have developed oral dysfunction would need an individualized intervention conducted by a multidisciplinary team RCT of CF timing in preterm infants Marriot et al. 2004 Gupta et al, 2017 Infants weaned at 13 weeks (intervention group) compared to infants weaned at 17 weeks (control group) • Similar growth parameters at 12 months of corrected age in preterm infants (<34 weeks of gestation) randomized to start weaning either at 4 or 6 months of corrected age • significantly increased rate of hospital admission in the 4 month group (18·1% vs 9.4%) • at 12 months of corrected age, had a greater increase in length growth velocity • Higher mean hemoglobin and serum iron levels at 6 months of corrected age Recommendation • Assess developmental readiness Watch for the baby’s ability to: • Remain sitting upright without support, can lean forward and return to stable upright position, Shoulder • and head muscles are strong enough for head control. • Have the hand control to pick up a small item intentionally and move it to the mouth. • Control the tongue that would allow food to be moved around the mouth. • Control their swallowing of saliva. • Make controlled chewing and munching movements when watching others eating https://www.issa.nl/sites/default/files/pdf/Publications/cross% 20sectoral/16.Module-ResponsiveFeeding-LOWRES.pdf Ann Nutr Metab 2012;60(suppl 2):31–38 Nutrient adequacy Protein and linear growth Intakes of tryptophan, protein, and energy, and serum levels of tryptophan and IGF-1 were positively correlated with the linear growth Tessema M, et al. Nutrients 2018, 10, 1776 PROTEIN QUALITY Food Sci Nutr. 2020;8:5379–5391. Protein content https://tools.myfooddata.com/nutritioncomparison/174272-172475-168878-170440/oz-oz-ozoz/1-1-1-1 Vegetarian and vegan mothers are capable of producing nutritionally valuable milk for their infants, as far as the appropriate supplementation compensating for breastfeeding mother’s nutritional requirements is provided. Karcz, K et al.Crit. Rev. Food Sci. Nutr. 2020, 22, 1–18 Baldassarre ME, et al. Int. J. Environ. Res. Public Health 2020, 17, 4835 Iron adequacy The Journal of Pediatrics 2015 167S1-S2 Dietary iron availability Bioavailability is the percentage (or fraction) of total intake that is absorbed and utilized for normal body functions. Proceedings of the Nutrition Society (2019), 78, 27–33 Iron content in selected commercially CF Matern Child Nutr.2019 Jun;15 Suppl 4(Suppl 4):e12789 Supplementation of fortification? • The proportion of infants with ID + IDA in the control group (n = 8, prevalence of 14.3%) was significantly higher than the proportion (n = 2, prevalence 2.5%) in the combined FeCer and FeMed groups • Medicinal iron was associated with a small but significant reduction in length gain and a trend toward reduced weight gain Am J Clin Nutr 2009;90:76–87. Sodium 2,300 mg Na = 1 level teaspoon table salt. Table salt (g) = sodium (g) × 2.5. Paediatrics and Child Health, 2020, 47–53 Food safety PENYIMPANAN MAKANAN YANG TELAH DIMASAK Makanan yang dimasak Kulkas (<5C) Freezer (<-15C) Buah/sayur disaring 2-3 hari 6-8 bulan Daging dan telur yang dihaluskan Daging dicampur sayur 1 hari 1-2 bulan 1-2 hari 1-2 bulan USDA. Food safety for children under 5. Feeding behaviour Sensitive period to introduce lumpy food is between 6-10 mo Munching can be seen as early as 7 mo Gag reflex is normal, differentiate with choking Modifying Food Texture, Volume 2. http://dx.doi.org/10.1016/B978-1-78242-334-8.00008-0 ATURAN MAKAN (FOOD RULES ) 1. PENJADWALAN Jadwal makan teratur & konsisten ▪ Selingan hanya yang sudah direncanakan ▪ Lama makan maksimal 30 menit ▪ Hanya air putih di antara waktu makan ▪ 2. LINGKUNGAN YANG NETRAL ❖ Proses makan sering berantakan, sediakan alas di bawah kursi sebagai tempat makanan jatuh/tumpah ❖ Tidak sambil bermain atau hal lain yang mengganggu proses makan (TV, games) Tidak menjadikan makanan sebagai hadiah ❖ 3. CARA PEMBERIAN ➢ Berikan dalam porsi kecil ➢ Dahulukan makanan padat, kemudian cair ➢ Dorong anak untuk makan sendiri ➢ Angkat makanan jika dalam 1015 menit anak lebih tertarik untuk bermain ➢ Hentikan proses makan jika anak marah ➢ Bersihkan mulut dan alat makan jika proses makan sudah selesai KMS di buku KIA Growth monitoring = BB/U Menilai tren pertumbuhan BB naik Pertumbuhan baik BB turun Pertumbuhan tidak baik BB naik tidak memadai Pertumbuhan tidak baik BB tetap /mendatar Pertumbuhan tidak baik Leaflet, booklet dan video tentang edukasi MPASI dari UKK Nutrisi & Penyakit Metabolik dapat diunduh gratis di: www.idai.or.id atau @idai_ig Isi: 150 menu (2021) THANK YOU Healthy eating habit start with a spoonful of trust and a slice of patience
