Protein-Reduced Complementary Foods Based on Nordic Ingredients Combined with Systematic Introduction of Taste Portions Increase Intake of Fruits and Vegetables in 9 Month Old Infants: A Randomised Controlled Trial

Abstract

Fruits and vegetables are healthy foods but under-consumed among infants and children. Approaches to increase their intake are urgently needed. This study investigated the effects of a systematic introduction of taste portions and a novel protein-reduced complementary diet based on Nordic foods on fruit and vegetable intake, growth and iron status to 9 months of age. Healthy, term infants (n = 250) were recruited and randomly allocated to either a Nordic diet group (NG) or a conventional diet group (CG). Infants were solely breast- or formula-fed at study start. From 4 to 6 months of age, the NG followed a systematic taste portions schedule consisting of home-made purées of Nordic produce for 24 days. Subsequently, the NG was supplied with baby food products and recipes of homemade baby foods based on Nordic ingredients but with reduced protein content compared to the CG. The CG was advised to follow current Swedish recommendations on complementary foods. A total of 232 participants (93%) completed the study. The NG had significantly higher intake of fruits and vegetables than the CG at 9 months of age; 225 ± 109 g/day vs. 156 ± 77 g/day (p < 0.001), respectively. Energy intake was similar, but protein intake was significantly lower in the NG (−26%, p < 0.001) compared to the CG. This lower protein intake was compensated for by higher intake of carbohydrate from fruits and vegetables. No significant group differences in growth or iron status were observed. The intervention resulted in significantly higher consumption of fruits and vegetables in infants introduced to complementary foods based on Nordic ingredients.

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

“…They bought all the ingredients and prepared the purées themselves. Composition and preparation of the recipes have been described in detail elsewhere [ 54 ]. The taste portion schedule was developed to introduce sweeter flavors and then to increase sour and bitter flavors ( Figure 3 ).…”

Infant feeding—a scoping review for Nordic Nutrition Recommendations 2023

“…Encouraging parents to introduce a variety of foods with 'more demanding' sensory qualities can be positive for later acceptance. A recent Swedish randomized controlled trial (RCT) (82) showed that starting complementary feeding with a systematic introduction of inherently sour or bitter-tasting Nordic fruits (apple), berries (raspberry, lingonberry, cranberry), roots (turnip, white radish), and vegetables (cauliflower) resulted in overall higher intakes of fruit and vegetables at 9, 12, and 18 months of age.…”

Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring

“…For this reason, vegan protein-rich alternatives with less fibre, such as tofu and seitan, may be preferable since these foods usually result in high satiety and might support appropriate protein intake [37,38]. First results from a Swedish trial of infants randomized to a diet with decreased protein intake, compared to a traditional Nordic diet has, thus far, shown no group differences in growth or iron status at 9 months of age [39]. Forthcoming results will glean further insight into the role of decreased protein intake, compared to a traditional Nordic diet, on anthropometric outcomes, metabolic and inflammatory biomarkers, as well as the gut microbiome [40].…”