Background/ Objectives: Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later, and subsequent breastfeeding and weaning behaviours.

Mothers in this study consider diet as an infant to be a less important influence on lifelong health than many lifestyle, behavioral, and environmental factors and genetics. Further dissemination of the implications of programming to consumers may be warranted.

Objective: To (i) identify and describe prevailing infant feeding policy documents in five diverse European countries; (ii) analyse types of health outcomes for the infant that are associated with feeding breast milk rather than formula milk in the documents of different countries; and (iii) assess the extent to which documents reflect the WHO global recommendation of exclusive breast-feeding for 6 months. Design: Documentary review and analysis. Setting: Five geographically dispersed countries of Europe (England, Finland, Germany, Hungary and Spain). Subjects: Policy documents on infant feeding were identified; statements that linked choice between breast-and formula-feeding to a health outcome for the infant were extracted. Results: Twenty-six documents (varied authorships, dates, length and character) were identified: four from England; two from Finland; nine from Germany; six from Hungary; and five from Spain. There was no consistency in the way in which health outcomes were cited as factors in the recommendations for breast-rather than formula-feeding. Seven documents contained no reference to the health implications of infant feeding choice. Of 203 statements in remaining documents citing health outcomes, 24?1 % mentioned general health effects, 32?5 % protection against infections, 31?5 % long-term conditions (e.g. diabetes, CVD) and 11?8 % mentioned allergy. Health outcomes were linked to exclusive breast-feeding in only 25 % of statements. Conclusions: Policy documents in the study countries varied in the extent to which they reflect the health outcomes for the baby of breast-feeding, and this may limit effective promotion by health professionals. There is scope to improve the process of bringing evidence and recommendations into policy documents.

Although the association between early nutrition and later health outcomes known as metabolic programming is well acknowledged amongst researchers, the extent to which this concept is being communicated to parents is not known. The frequency and content of programming statements found in written materials aimed at parents and produced by national governmental bodies, professional and consumer associations, special interest groups and industry were reviewed in five European countries. Stand-alone leaflets, pamphlets and booklets (termed leaflets) targetted towards parents and published from 2000 to 2005 and all issues from 2005 of the most popular monthly parenting magazine providing information on the feeding of healthy infants aged 0-12 months were sourced in each country. Materials targetting older children, mothers or health professionals and focusing on legal and practical aspects or specific diseases were excluded. Altogether 130 documents (England thirty-six, Finland eight, Germany fourteen, Hungary thirty-eight, Spain thirty-four) and 161 articles and notes from sixty magazine issues were screened for nutrition programming statements on nutrients, food items and feeding behaviour in relation to short-term (<5 years), medium-term (5-15 years) and long-term (>15 years) health outcomes of the infant. Statements on non-nutritive substances, non-feeding-related behaviour, vitamin and mineral supplementation and nutrient deficiencies were excluded. In total 638 programming statements were identified. It was found that 76.0 % (n 100) of the leaflets and 41.4 % (n 66) of the magazine articles and notes contained programming statements. The percentage of statements in all materials was highest in Spain (88.6), followed by Hungary (67.3), Germany (50.8), Finland (45.8) and England (42.2) (P<0.001). The most frequently documented health outcomes are listed in the Table. The dominating category for England, Germany and Hungary was allergy, whereas it was risk of infections for Spain and growth and development for Finland. The majority of statements (68.2 %, n 435) did not refer to the duration of the programming effects; of the remaining statements 18.2 % (n 122) referred to short-term, 5.1 % (n 33) to medium-term and 7.5 % (n 48) to long-term programming effects. The most frequently mentioned health outcomes for short-term programming were risk of infections (30.3 %), allergy (16.4 %) and risk of diseases in general (14.8 %), and for long-term programming those mentioned were obesity (22.9 %), the risk of CVD (14.6 %) and health in general (14.6 %).

Parents’ decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices