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NHD CPD eArticle NETWORK HEALTH DIGEST

Volume 8.13 - 16th August 2018

INFANT WEANING AND DEVELOPMENT OF TASTE PREFERENCES Jacqui Lowdon Paediatric Dietitian, Leeds Children’s Hospital Jacqui is a Clinical Specialist in Paediatric Cystic Fibrosis at Leeds Children's Hospital. She previously specialised in gastroenterology and cystic fibrosis. Although her career to date has focused on the acute sector, Jacqui has a great interest in paediatric public health.

Taste is one of our fundamental senses, essential for us to be able to ingest nutritious food and to be able to detect and avoid potentially poisonous ones. During the early years, the foundations for healthy growth and development are laid down. Complementary feeding, that is when foods other than milk are first introduced (commonly referred to as weaning), is a critical feature of this time, both in terms of nutrition and eating behaviours.1 As we tend to eat food that we like, the most important aspect to acquire during these early years should be to develop a preference for certain foods that may contribute towards good health. Strong correlations have been found between food preferences during early childhood and preferences in later childhood,2 adolescence3 and young adulthood.4 This implicates early experience as a foundation for food preference development across the course of our life. THE BASIC TASTES

During the first year of life, we are receptive to all five basic tastes, with varying extents, but willing to try most new foods.5 However, it is well documented that from birth, humans prefer sweet, salty and umami tastes over bitter or sour.6,7 Umami is a strong taste, often referred to as ‘the fifth taste’, that is not sweet, sour, salty, or bitter. It is the intensely savoury taste imparted by glutamates that occur naturally in many foods such as meat, fish and vegetables. More recently, fatty acids and calcium have emerged as potential tastants that can be sensed by taste bud

cells.8-12 Humans can also quickly learn to like foods that are energy dense.13 For example, children may be more sensitive to certain tastes (for example, sweet) during periods of maximal growth,14,15 which has been hypothesised to help choose foods that will support rapid development.14 Exposure to a variety of foods during the complementary feeding period helps with the acceptance of new foods in the first year, whereas in the second year, exposure may have a more limited impact.16 VARIETY PROMOTES ACCEPTANCE

Reactions towards new foods can differ according to food groups.17 In one study, mothers were asked to report their infant’s reactions to new foods at the beginning of complementary feeding. They found that fruits and vegetables, which are often the first foods offered to infants, are less accepted than other food groups.18 However, a more recent investigation demonstrated that early exposure to a rotation of vegetable flavours first added to milk and then to cereals increased the intake and liking of these vegetables. Infants assigned to the

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NHD CPD eArticle

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Food neophobia is defined as ‘an unwillingness to eat novel foods’. It is thought to be an adaptive behaviour, to ensure that children eat foods that are familiar and safe during a period when they are being exposed to a large number of new foods. intervention ate more of the target vegetables in the laboratory and at home than those assigned to the control group.19 This reinforces the findings that variety can also promote infants’ acceptance of new foods.20 COMMENCEMENT OF COMPLEMENTARY FEEDING AND ITS ROLE IN THE DEVELOPMENT OF TASTE PREFERENCES

Timing of exposure to new foods has also been demonstrated to influence infants’ food acceptance. Complementary feeding is recom-mended to start at around six months of age,21 although some suggest that it is appropriate to start between four and six months of age, when the infant can demonstrate signs that they are ready for solid food, e.g. sitting up unaided, coordinating hand and mouth movements.22-24 For more on complementary feeding, please turn to Maeve Hanan’s article on pages 29-31. Potential issues with introducing solid foods after six months, including evidence suggesting that it might increase the risk of developing certain allergies25 and the development of low iron levels,26 is that part of the ‘window of opportunity’ for obtaining a broad range of food preferences may be missed.27 Using a parent-rated scale of four attributes of the infant’s reaction to the food , it has been shown that the earlier the introduction to vegetables

during complementary feeding, the greater the acceptance of novel vegetables.28 It is more difficult to increase children’s acceptance of fruits and vegetables after toddlerhood.29,30 It may be acceptable then, in terms of food acceptance, that the four- to six-month period can be an appropriate time to introduce ‘tastes’ of solid food. However, it does have to come with strict criteria: a focus on ‘food familiarisation’ rather than nutrition per se, ‘tiny tastes’ of foods that are appropriate in type and texture suitable for the developmental age of the infant and in amounts that do not compromise breastfeeding. EARLY YEARS’ FOOD PREFERENCES AFFECTING ACROSS-THE-LIFE-COURSE

It has been well documented, albeit mostly observational, that food preferences developed during the early years can ‘track’ into later childhood. Most of the evidence is derived from prospective cohort studies, including data from large cohorts such as the Avon Longitudinal Study of Parents and Children (ALSPAC)31,32 and the Infant Feeding Practices Study II,33 as well as smaller cohorts.34-36 There is also evidence indicating that early familiarisation can be associated with later acceptance. For example, protein hydrolysate formulas, which have a particularly bitter taste, are associated with later acceptance for bitter foods, including vegetables and fruit.37

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NHD CPD eArticle Experimental data has also demonstrated a link between introducing a variety of vegetables at the onset of complementary feeding38 with acceptance of these foods in early life and over the longer term, up to six years of age.39 Salt taste is unique, in that a preference for salt taste develops after four months of age and continues into childhood.40 The two strongest predictors of young children’s food preferences are familiarity and sweetness.41 FOOD NEOPHOBIA

Food neophobia is defined as ‘an unwillingness to eat novel foods’. It is thought to be an adaptive behaviour, to ensure that children eat foods that are familiar and safe during a period when they are being exposed to a large number of new foods.42,45 Young children, especially aged two to five years old, exhibit heightened levels of food neophobia during this time of rapid dietary change. Rozin et al43,44 have demonstrated that distaste, defined as the ‘dislike of the sensory characteristics of a food’, appears to be the strongest driver of neophobia in young children, followed by potential harm or sickness. As mentioned above, the two strongest predictors of young children’s food preferences are familiarity and sweetness. These innate tendencies, along with a predisposition to learn from early experiences through associative learning46,47 and repeated exposure,48-50 allow the child to learn to accept and prefer foods that are available within their environment. Experimental studies have demonstrated that neophobic tendencies can be reduced and preferences increased on exposing infants and young children to novel foods repeatedly,48,49,51,52 suggesting that young children need to be exposed

Volume 8.13 - 16th August 2018

to a novel food six to 15 times before an increase in intake and preferences can be seen.48,49,51,52 Furthermore, exposure needs to include tasting the food, as merely seeing49 or learning52 about a novel food on repeated occasions does not promote their preferences for that food. A recent intervention study found that repeatedly exposing children to a novel food with positive social environment factors was especially effective in increasing their willingness to try and have preference for the novel food, as well as other novel foods not targeted by the intervention.53 These findings suggest the importance of the act of repeatedly exposing children to new foods and the context within which this occurs. EUROPEAN APPROACHES TO COMPLEMENTARY FEEDING

This idea of early ‘food familiarisation’ aligns with French, Swedish and Dutch approaches to early complementary feeding, providing the infants with plenty of opportunity to experience different foods, with an emphasis on ‘tiny tastes’ and ‘educating the palate’.54-56 CONCLUSION

It is of paramount importance that, during the early years, we can acquire the preference for foods that promote a varied and healthy diet. The complementary feeding period is a ‘window of opportunity’, familiarising infants with a wide variety of foods. At this stage, their openness to try new foods is at its peak, making early intervention the most promising way of improving children’s diets. Familiar foods are likely to become preferred foods and it has been demonstrated that these acquired preferences can track into later childhood and into adulthood, thus affecting food choices in later life.

References 1 Birch LL and Doub AE (2014). Learning to eat: birth to age 2 years. American Journal of Clinical Nutrition 99: 723S-8S 2 JD Skinner, BR Carruth, B Wendy, PJ Ziegler. Children’s food preferences: a longitudinal analysis. J Am Diet Assoc, 102 (2002), pp 1638-1647 3 T Nu, J MacLeod, J Barthelemy. Effects of age and gender on adolescents’ food habits and preferences. Food Qual Pref, 7 (1996), pp 251-262 4 S Nicklaus, V Boggio, C Chabanet, S Issanchou. A prospective study of food preferences in childhood. Food Qual Pref, 15 (2004), pp 805-818 5 Schwartz C, Chabanet C, Lange C et al (2011). The role of taste in food acceptance at the beginning of complementary feeding. Physiology and Behaviour 104: 646-52 6 Beauchamp GK and Mennella JA (2009). Early flavour learning and its impact on later feeding behaviour. Journal of Pediatric Gastroenterology and Nutrition, 48: S25-30 7 Schwartz C, Issanchou S and Nicklaus S (2009). Developmental changes in the acceptance of the five basic tastes in the first year of life. British Journal of Nutrition, 102: 1375-85 8 Iwata S, Yoshida R, Ninomiya Y. Taste transductions in taste receptor cells: basic tastes and moreover. Current pharmaceutical design. 2014; 20: 2684-2692 9 Liman ER, Zhang YV, Montell C. Peripheral coding of taste. Neuron. 2014; 81: 984-1000 10 Passilly-Degrace P, Chevrot M, Bernard A, Ancel D, Martin C, Besnard P. Is the taste of fat regulated? Biochimie. 2014; 96: 3-7 11 Tucker RM, Mattes RD, Running CA. Mechanisms and effects of ‘fat taste’ in humans. Biofactors. 2014; 40: 313-326 12 Tordoff MG, Reed DR, Shao H. Calcium taste preferences: genetic analysis and genome screen of C57BL/6J×PWK/PhJ hybrid mice. Genes, brain, and behaviour. 2008b; 7: 618-628 Copyright © 2018 NH Publishing Ltd - All rights reserved. Available for printing and sharing for the use of CPD activities for personal use. Not for reproduction for publishing purposes without written permission from NH Publishing Ltd.


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13 Birch LL (1992). Children’s preferences for high‐fat foods. Nutrition Reviews 50: 249-55 14 SE Coldwell, TK Oswald, DR Reed. A marker of growth differs between adolescents with high vs low sugar preference. Physiol Behav, 96 (2009), pp 574-580 15 Bouhlal S, Issanchou S, Chabanet C, Nicklaus S. ‘Just a pinch of salt’. An experimental comparison of the effect of repeated exposure and flavour-flavour learning with salt or spice on vegetable acceptance in toddlers. Appetite 2014, 83, 209-217 16 Nicklaus S. The role of food experiences during early childhood in food pleasure learning. Appetite 2016, 104, 3-9 17 Lange C, Visalli M, Jacob S, Chabanet C, Schlich P, Nicklaus S. Maternal feeding practices during the first year and their impact on infants’ acceptance of complementary food. Food Qual Preference 2013, 29, 89-98 18 Hetherington MM, Schwartz C, Madrelle J, Croden F, Nekitsing C, Vereijken CMJL, Weenen H. A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure. Appetite 2015, 84, 280-290 19 Wadhera D, Phillips EDC, Wilkie LM. Teaching children to like and eat vegetables. Appetite (2015) 93:75-84.10.1016/j.appet.2015.06.016 20 Drewnowski A. Sensory control of energy density at different life stages. Proc Nutr Soc, 59 (2000), pp 239-244 21 Department of Health (2011). Introducing solid foods. Available at: www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/introducing-solid-foods.pdf (accessed April 2018) 22 Butte N, Cobb K, Dwyer J et al (2004). The Start Healthy Feeding Guidelines for Infants and Toddlers. Journal of the American Dietetic Association 20: 442-54 23 Pac S, McMahon K, Ripple M et al (2004). Development the Start Healthy Feeding Guidelines for Infants and Toddlers. Journal of the American Dietetic Association, 104, 455-67 24 EFSA (European Food Safety Authority) Panel on Dietetic Products, Nutrition and Allergies (2009). Scientific opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Journal 7: 1423, 2-38 25 Perkin MR, Logan K, Tseng A et al (2016). Randomised trial of introduction of allergenic foods in breast‐fed infants. New England Journal of Medicine 374: 1733-43 26 Lange C, Visalli M, Jacob S, Chabanet C, Schlich P, Nicklaus S. Maternal feeding practices during the first year and their impact on infants’ acceptance of complementary food. Food Qual Prefer (2013), 29(2): 89-98.10.1016/j.foodqual.2013.03.005 27 Mennella JA. Ontogeny of taste preferences: basic biology and implications for health. Am J Clin Nutr (2014), 99(3): 704S-11S.10.3945/ajcn.113.067694 28 Mennella JA, Trabulsi JC. Complementary foods and flavour experiences: setting the foundation. Ann Nutr Metab (2012), 60(2): 40-50.10.1159/000335337 29 Agostoni C, Decsi T, Fewtrell M et al. (2008). Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 46: 99i110 30 Coulthard H, Harris G and Fogel A (2014). Exposure to vegetable variety in infants weaned at different ages. Appetite 78: 1-6 31 Coulthard H, Harris G and Emmett P (2009). Delayed introduction of lumpy foods to children during the complementary feeding period affects child’s food acceptance and feeding at seven years of age. Maternal & Child Nutrition 5: 75-85 32 Coulthard H, Harris G and Emmett P (2010). Long‐term consequences of early fruit and vegetable feeding practices in the United Kingdom. Public Health Nutrition 13: 2044-51 33 Grimm KA, Kim SA, Yaroch AL et al (2014). Fruit and vegetable intake during infancy and early childhood. Pediatrics 134: S63-9 34 Skinner JD, Carruth BR, Bounds W et al (2002b). Children’s food preferences: a longitudinal analysis. Journal of the American Dietetic Association 102: 1638-47 35 Gregory JE, Paxton SJ and Brozovic AM (2011). Maternal feeding practices predict fruit and vegetable consumption in young children. Results of a 12‐month longitudinal study. Appetite 57: 167-72 36 Foterek K, Hilbig A and Alexy U (2015). Associations between commercial complementary food consumption and fruit and vegetable intake in children. Results of the DONALD study. Appetite 85: 84-90 37 Mennella JA and Beauchamp GK (2002). Flavour experiences during formula feeding are related to preferences during childhood. Early Human Development 68: 71-82 38 Maier AS, Chabanet C, Schaal B et al (2008). Breastfeeding and experience with variety early in weaning increase infants’ acceptance of new foods for up to two months. Clinical Nutrition 27: 849-57 39 Maier‐Nöth A, Schaal B, Leathwood P et al (2016). The lasting influences of early food‐related variety experience: a longitudinal study of vegetable acceptance from 5 months to 6 years in two populations. PLoS one 11: e0151356 40 GK Beauchamp, BJ Cowart, M Moran. Developmental changes in salt acceptability in human infants. Dev Psychobiol, 19 (1986), pp 17-25 41 LL Birch. Dimensions of preschool children’s food preferences. J Nutr Educ, 11 (1979), pp 77-80 42 P Pliner, M Pelchat, M Grabski. Reduction of neophobia in humans by exposure to novel foods. Appetite, 20 (1993), pp 111-123 43 P Rozin, L Hammer, H Oster, T Horowitz, V Marmora. The child’s conception of food: differentiation of categories of rejected substances in the 16 months to 5 year age range. Appetite, 7 (1986), pp. 141-151 44 AE Fallon, P Rozin, P Pliner. The child’s conception of food: the development of food rejections with special reference to disgust and contamination sensitivity. Child Dev, 55 (1984), pp 566-575 45 LL Birch. Dimensions of preschool children’s food preferences. J Nutr Educ, 11 (1979), pp. 77-80 46 LL Birch, L McPhee, L Steinberg, S Sullivan. Conditioned flavour preferences in young children. Physiol Behav, 47 (1990), pp 501-505 47 SL Johnson, L McPhee, LL Birch. Conditioned preferences: young children prefer flavours associated with high dietary fat. Physiol Behav, 50 (1991), pp 1245-1251 48 S Anzman-Frasca, JS Savage, ME Marini, JO Fisher, LL Birch. Repeated exposure and associative conditioning promote preschool children’s liking of vegetables. Appetite, 58 (2011), pp 543-553 49 49. LL Birch, L McPhee, BC Shoba, E Pirok, L Steinberg. What kind of exposure reduces children’s food neophobia? Looking vs tasting. Appetite, 9 (1987), pp 171-178 50 JA Mennella, CP Jagnow, GK Beauchamp. Prenatal and postnatal flavour learning by human infants. Pediatrics, 107 (2001), pp E88-E93 51 LL Birch, DW Marlin. I don’t like it; I never tried it: effects of exposure on two-year-old children’s food preferences. Appetite, 3 (1982), pp 353-360 52 J Wardle, LJ Cooke, EL Gibson, M Sapochnik A Sheiham, M Lawson. Increasing children’s acceptance of vegetables; a randomised trial of parent-led exposure. Appetite, 40 (2003), pp 155-162 53 SL Johnson, L Bellows, L Beckstrom, J Anderson. Evaluation of a social marketing campaign targeting preschool children. Am J Health Behav, 31 (2007), pp. 44-55 54 Swedish National Food Agency (2012). Good food for infants under one year. www.livsmedelsverket.se/globalassets/english/food-habits-health-environment/ dietary-guidelines/good-food-for-infants-under-one-year.pdf (accessed April 2018) 55 Schwartz C, Madrelle J, Vereijken CMJL et al (2013). Complementary feeding and ‘donner les bases du goût’ (providing the foundation of taste). A qualitative approach to understand weaning practices, attitudes and experiences by French mothers. Appetite 71: 321-31 56 Netherlands Nutrition Centre (2016). Available at: www.voedingscentrum.nl/eerstehapjes (accessed April 2018) Copyright © 2018 NH Publishing Ltd - All rights reserved. Available for printing and sharing for the use of CPD activities for personal use. Not for reproduction for publishing purposes without written permission from NH Publishing Ltd.


NHD CPD eArticle NETWORK HEALTH DIGEST

Volume 8.13 - 16th August 2018

Questions relating to: Infant weaning and development of taste preferences Type your answers below, download and save or print for your records, or print and complete by hand. Q.1

Explain the tastes that humans are receptive to.

A

Q.2

How can variety promote infants’ acceptance of new foods?

A

Q.3

Explain why the four- to six-month period can be an appropriate time to introduce ‘tastes’ of solid food.

A

Q.4

What is the strict criteria required for food acceptance at four to six months.

A

Q.5

How can complimentary feeding help with fussy eating?

A

Q.6

Describe how food preferences developed during the early years can ‘track’ into later childhood.

A

Q.7

What is food neophobia?

A

Q.8

How can food neophobic tendencies be reduced in infants?

A

Please type additional notes here . . .

Copyright © 2018 NH Publishing Ltd - All rights reserved. Available for printing and sharing for the use of CPD activities for personal use. Not for reproduction for publishing purposes without written permission from NH Publishing Ltd.

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NHD CPD eArticle Vol 8.13  

Infant weaning and development of taste preferences by Jacqui Lowdon

NHD CPD eArticle Vol 8.13  

Infant weaning and development of taste preferences by Jacqui Lowdon

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