The first 1,000 days of dinner

When UNICEF ranked New Zealand as the second-worst nation for child obesity in 41 OECD and EU countries in its report The State of the World’s Children 2019, New Zealand researchers were not surprised.

The trend has been apparent since 1990 with the increase in overweight children climbing by 44.6 percent in 30 years. The report found that almost 40 percent of children and teens aged 5-19 were overweight. Only the United States has a worse record. This means our children are more likely to be overweight than Australian and British children. When it comes to adult obesity New Zealand is a close third behind Mexico, but our children are now fatter than Mexican children.

Without serious action, the World Health Organisation estimates that by 2025, there will be 70 million overweight or obese infants and young children worldwide. As they grow, they face higher rates of heart disease, diabetes, degenerative disease of the joints and some cancers. Poor health trends in the population can be expressed as data points, but the personal burden on the health, well-being and later lives of those children and their families will take its own toll.

Professor Clare Wall of the Faculty of Medical and Health Sciences at the University of Auckland leads the nutrition department. Her own research has focused on nutrition in infants and how that nutrition affects their health as children and as they age and she is one of the authors of a key piece of work. If our children are facing an obesity epidemic, it makes sense to go back to the first 1,000 days of life and find out what they are eating. The patterns of food choice, food type and eating culture are formed early and how infants eat and what they like to eat provide important insight into the diet and habits that lead to obesity.

Professor Wall says, “We know it’s a really essential window to get things right for so many developmental milestones and we know that nutrition is critical.”
 

Setting the right path in the first thousand days in a child’s life is not just to avoid obesity, it helps guide children to grow to their potential. About 80 percent of the brain is developed by the age of two.
Professor Wall says, “The amount of brain growth is phenomenal. They kind of grow into their heads. So if the brain is not getting the right nutrients, especially iron and zinc at this stage, development will be affected. Nor is it reversible. It could be too late by five-year-old to rectify this."

New Zealand has had national infant feeding guidelines since 2008, setting out how parents and caregivers should feed healthy infants and toddlers. They range from recommending exclusive breast feeding until around six months of age, to offering toddlers food from each of the four main food groups (fruit and vegetables, breads and cereals, milk, lean meat, legumes, nuts and seeds) and limiting high sugar and salt in foods as they switch from a milk based diet to solid food.

But prior to a key piece of research carried out by Wall and colleagues from the University of Auckland, nobody really knew what our infants were eating. Their work, commissioned by the Ministry of Social Development was published as Infant Feeding in New Zealand. The data comes from the Growing up in New Zealand (GUiNZ) study, hosted by the University of Auckland.

This cohort study has followed 6432 children since birth. Those children are now aged 10 and the study has produced a wealth of data and insight into our children’s lives. Wall and the team combed through responses to questionnaires and data gathered when the cohort of children was nine months old.
 

To establish a baseline to measure how New Zealand’s infants do nationally, the team devised an Infant Feeding Index (IFI), a distillation of the key measures and milestones in the infant feeding guidelines to enable tracking of the complex array of diet variables as infant age and hit their developmental milestones. They ended up with an IFI that gives a score of 100 if the feeding guidelines are fully followed.

When rated against the new Infant Feeding Index, the average score for the children’s diet was 70 out of a top score of 100. Only 1.5 percent of infants achieved the “ideal” score of 100, but almost a third of the cohort scored 80 points or more, which Wall says, is a promising result.

The main concern she has is the relatively low score for the important factor of breast feeding exclusively to around six months of age and continued breastfeeding along with other foods to one year and beyond. Only 15.8 percent of the infants achieved this, so New Zealand is very unlikely to meet the world target for breastfeeding set by WHO to have 50 percent of all infants exclusively breastfeeding until six months old. If achieved, the evidence is clear that these infants would lead healthier and longer lives.

Wall says parents and caregivers do their best, though often end up tacking against the contrary winds of socioeconomic pressure. “The infant diet has changed in a similar way to the adult diet,” she says. “More processed food, more salt, more sugar and more fat.”

As the infant grows up, it naturally becomes more and more part of the family and their family’s food environment. “There’s less time and so it becomes harder to prepare separate meals for infants,” she says, with infants often eating the same food as the adults.

“Your food preferences and behaviour start in early childhood. Often if a child has done well, they get a sweet, so we associate lollies with being good. The foods we crave are the ones that influence our pleasure,” says Wall. If you happen to be raised in a family with limited access to heathy foods it is that much harder to change your eating habits as an adult. “Unfortunately we have overweight children who will grow up to be obese adults.”

While diet is important, equally influential is how we eat. If a household has daily rituals like eating breakfast at home, eating together as a family and not watching television or screens while having meals, they are much more likely to eat a healthy diet.  

But that is often more aspiration than reality. The contemporary young family in our largest city Auckland lives life in a blur of work, day care, commutes from hell, drop-offs and pick-ups.

Convenience, in all spheres of life, including cooking, becomes highly desirable. Contemporary cooks may not realise how processed their food is compared to their parents’ generation.

Wall says, “I think we’re now experiencing this whole change in terms of our food. It's not just about what people are eating and the amount of nutrients they take in, but also the sorts of formats of the foods that we're eating and how removed they have become from the foods and diets that we used to eat.

“Eating a chicken nugget is not the same as sitting down to eat a roast chicken for dinner. Our meals are eaten more quickly and for that to be possible, a lot of food lacks texture so they’re easy to eat on the run.”

We know this instinctively, she says, a homemade burger is going to have vegetables, cucumber and tomato in it, the buns are likely to be wholegrain. The experience will be quite different to a fast food chain product.“There’s going to be a lot more chewing in the homemade burger.”

As food becomes more processed, it’s not only faster to eat but also easier to consume larger volumes. “There is a concern that our children from a very young age are overconsuming because it’s so easy to eat.”

To look more closely at not only the infant diet, but the impact of how infants are eating, Wall and colleague Professor Bryony James from the Faculty of Engineering are investigating the potential impacts from a rising trend in convenience food for infants: puree foods in plastic pouches. According to the New York Times, these have risen to be a quarter of all baby food sales in the United States. ”The idea is that the product is only to be used by squeezing into a bowl and eaten with a spoon, but people give it to infants to feed themselves,” says Wall.

Apple or a meat puree is not the same as biting into an apple or chewing on meat. Slurping your food means not developing the dexterity to manage a spoon. A puree is always going to be more energy dense and processed than a whole food, like a slice of apple.

Wall and James have designed a trial to test whether infants feeding from pouches changes the development of their bite. A good bite is essential for the development of jaw muscles and teeth, which in turn are important for language development. Delayed language development and motor skills have big implications for brain development and learning.

“So the question is, are we breeding a generation who are used to only consuming mush and soft foods and who are missing development windows?” asks Wall.

As for the larger research into what our infants are eating, the team is returning to the GUiNZ data to see what has actually happened to the children, who at nine months, were not scoring high on the Infant Feeding Index. They want to know if their predictions have become a reality.