The Effect of Weaning with Adult Food Typical of the Mediterranean Diet on Taste Development and Eating Habits of Children: A Randomized Trial

Abstract

Mediterranean Diet (Med Diet) is one of the healthiest dietary patterns. We aimed to verify the effects of weaning (i.e., the introduction of solid foods in infants previously fed only with milk) using adult foods typical of Med Diet on children eating habits, and on the microbiota composition. A randomized controlled clinical trial on 394 healthy infants randomized in a 1:1 ratio in a Med Diet group weaned with fresh; seasonal and tasty foods of Med Diet and control group predominantly weaned with industrial baby foods. The primary end point was the percentage of children showing a good adherence to Med Diet at 36 months. Secondary end points were mother’s changes in adherence to Med Diet and differences in children gut microbiota. At 36 months, children showing a good adherence to Med Diet were 59.3% in the Med Diet group and 34.3% in the control group (p < 0.001). An increase in adherence to the Med Diet was observed in the mothers of the Med Diet group children (p < 0.001). At 4 years of age children in the Med Diet group had a higher gut microbial diversity and a higher abundance of beneficial taxa. A Mediterranean weaning with adult food may become a strategy for early nutritional education, to develop a healthy microbiota, to prevent inflammatory chronic diseases and to ameliorate eating habits in children and their families.

Keywords: Mediterranean Diet; complementary feeding; fresh foods; gut microbiota; taste development.

Figure 1

Study Flow-chart.

Figure 2

Differences between groups according to the single items of the KidMed questionnaire. Between groups differences for each item were assessed using the Chi square test without adjustment for multiple comparisons.

Figure 3

Longitudinal trajectories of KidMed score in children stratified by treatment arm. Results are expressed as Estimated Marginal Means (EMM) with the corresponding 95% Confidence Intervals (95% CIs). EMM’s were based on a linear mixed models using time as categorical factor.

Figure 4

Complete linkage clustering of subjects based on gut microbiota composition at genus level. Only genera with a median absolute abundance >2% were considered. The Canberra metric was used to compute distance between each pair of subjects.

Figure 5

Boxplots showing the relative abundance of microbial taxa between the Med Diet group (green) and controls (pink). (A): boxes represent the interquartile range (IQR) between the first and third quartiles and the line inside represents the median (2nd quartile). Whiskers denote the lowest and the highest values within 1.5 × IQR from the first and third quartiles, respectively. Between groups differences were assessed by applying pairwise Wilcoxon test. (B): Violin plots showing the difference in four alpha-diversity indices between the Med Diet group and controls. Wilcoxon’s rank sum test was used to assess the significance.