Acceptance of a Nordic, Protein-Reduced Diet for Young Children during Complementary Feeding-A Randomized Controlled Trial

Abstract

Early life is critical for developing healthy eating patterns. This study aimed to investigate the effects of a Nordic, protein-reduced complementary diet (ND) compared to a diet following the current Swedish dietary guidelines on eating patterns and food acceptance. At 4-6 months (mo) of age infants were randomized to a Nordic group (NG, n = 41) or a Conventional group (CG, n = 40), and followed until 18 mo of age. Daily intake of fruits and vegetables (mean ± sd) at 12 mo was significantly higher in the NG compared to the CG: 341 ± 108 g/day vs. 220 ± 76 g/day (p < 0.001), respectively. From 12 to 18 mo, fruit and vegetable intake decreased, but the NG still consumed 32% more compared to the CG: 254 ± 99 g/day vs. 193 ± 67 g/day (p = 0.004). To assess food acceptance, both groups were tested with home exposure meals at 12 and 18 mo. No group differences in acceptance were found. We find that a ND with parental education initiates healthy eating patterns during infancy, but that the exposure meal used in the present study was insufficient to detect major differences in food acceptance. This is most likely explained by the preparation of the meal. Nordic produce offers high environmental sustainability and favorable taste composition to establish healthy food preferences during this sensitive period of early life.

Keywords: eating behavior; environment; food preference; fruits; healthy eating; infant feeding; repeated exposure; sustainable eating; vegetables.

Figure 1

Flowchart of the current study in relation to the optimized complementary feeding study (OTIS) study. ¹ Declined to participate; too much work in the study or too long study period or will not give their child the specific study diet.

Figure 2

Flow diagram of the study. ¹ The Conventional group (CG) parents received written information from the Swedish Food Agency with the current recommendations for infants.

Figure 3

The taste portion schedule with the repeated exposures of fruits and vegetables in the Nordic group from 4 to 6 mo of age. Three exposures per day during three consecutive days per each fruit/berry or vegetable purée, in total 72 exposures during 24 days. ¹ Buckthorn berry, a seasonal product was replaced by lingonberry when shortage appeared.

Figure 4

(a) Sensory profiles of the different fruit and berry purées in the taste portion schedule together with mango purée, a commercial product from Semper AB; (b) sensory profiles of the different vegetable purées in the taste portion schedule together with corn-potato purée, a commercial product from Semper AB; (c) sensory profile of the cauliflower spread of the exposure meal compared to the cauliflower purée in the taste portion schedule; (d) sensory profile of the cranberry yogurt in the exposure meal compared to the cranberry purée in the taste portion schedule; (e) sensory profile of the lingonberry milk of the exposure meal compared to the lingonberry purée in the taste portion schedule. Significant differences across the sensory attributes * p < 0.05, ** 0.01< p < 0.05, *** p < 0.001.

Figure 4

(a) Sensory profiles of the different fruit and berry purées in the taste portion schedule together with mango purée, a commercial product from Semper AB; (b) sensory profiles of the different vegetable purées in the taste portion schedule together with corn-potato purée, a commercial product from Semper AB; (c) sensory profile of the cauliflower spread of the exposure meal compared to the cauliflower purée in the taste portion schedule; (d) sensory profile of the cranberry yogurt in the exposure meal compared to the cranberry purée in the taste portion schedule; (e) sensory profile of the lingonberry milk of the exposure meal compared to the lingonberry purée in the taste portion schedule. Significant differences across the sensory attributes * p < 0.05, ** 0.01< p < 0.05, *** p < 0.001.

Figure 4

(a) Sensory profiles of the different fruit and berry purées in the taste portion schedule together with mango purée, a commercial product from Semper AB; (b) sensory profiles of the different vegetable purées in the taste portion schedule together with corn-potato purée, a commercial product from Semper AB; (c) sensory profile of the cauliflower spread of the exposure meal compared to the cauliflower purée in the taste portion schedule; (d) sensory profile of the cranberry yogurt in the exposure meal compared to the cranberry purée in the taste portion schedule; (e) sensory profile of the lingonberry milk of the exposure meal compared to the lingonberry purée in the taste portion schedule. Significant differences across the sensory attributes * p < 0.05, ** 0.01< p < 0.05, *** p < 0.001.

Figure 5

(a) Mean daily fruit and vegetable intake (g/day) at 6, 12 and 18 mo of age; (b) mean daily fruit intake (g/day) at 6, 12 and 18 mo of age; (c) mean daily vegetable intake (g/day) at 6, 12 and 18 mo of age; (d) mean daily root vegetable intake (g/day) at 6, 12 and 18 mo of age. Fruit juices, vegetable juices, potatoes, chili, garlic, ginger and herbs are not included in the calculations. Whiskers indicate 95% confidence intervals. p-values indicate between group differences.

Figure 5

(a) Mean daily fruit and vegetable intake (g/day) at 6, 12 and 18 mo of age; (b) mean daily fruit intake (g/day) at 6, 12 and 18 mo of age; (c) mean daily vegetable intake (g/day) at 6, 12 and 18 mo of age; (d) mean daily root vegetable intake (g/day) at 6, 12 and 18 mo of age. Fruit juices, vegetable juices, potatoes, chili, garlic, ginger and herbs are not included in the calculations. Whiskers indicate 95% confidence intervals. p-values indicate between group differences.

Figure 5

(a) Mean daily fruit and vegetable intake (g/day) at 6, 12 and 18 mo of age; (b) mean daily fruit intake (g/day) at 6, 12 and 18 mo of age; (c) mean daily vegetable intake (g/day) at 6, 12 and 18 mo of age; (d) mean daily root vegetable intake (g/day) at 6, 12 and 18 mo of age. Fruit juices, vegetable juices, potatoes, chili, garlic, ginger and herbs are not included in the calculations. Whiskers indicate 95% confidence intervals. p-values indicate between group differences.