Getting it right from the start: Childhood nutrition and obesity prevention. Alumni Webinar

– [Sam] Hello, and welcome to this Deakin
University Alumni Webinar with presenters Dr. Jazzmin Zheng,
Dr. Rachel Laws, and an introduction
from Prof. Karen Campbell. Sam Johnstone here from the Deakin Alumni
Relations team. It’s great to have you with us. I’d like to start by acknowledging the
traditional owners of the land from which we’re broadcasting today,
the Wurundjeri people of the Kulin nations, and to pay our respects to
their elders, past, present, and emerging. Today, we are broadcasting from the
Burwood Campus, and our webinar topic is “Getting it right from the Start:
Childhood nutrition and obesity prevention.” Now, as we introduce our presenters and to
frame today’s discussion, it’s my pleasure
to introduce Professor Karen Campbell from Deakin’s Institute for
Physical Activity and Nutrition. Over to you, Karen. – [Prof. Campbell] Thanks, Sam.
So, as Sam said, I’m Karen Campbell. I’m the Professor of Population Nutrition
within the Institute for Physical Activity and Nutrition, and I have the great
pleasure of heading up a team of stellar researchers in the…a stream called the
“Nutrition in pregnancy, early years, and childhood” research stream. You can see our pictures along the bottom
here, and I guess I’m very proud of the fact that many of these fabulous
researchers are homegrown within the institute. So I wanted today to take a little bit of
time just to frame the kind of research we do within our stream, and to highlight,
I guess by this circular notion, the fact that we work across epidemiology,
which means describing behaviors, and, in this case, the dietary predictors of
health across life. We’re particularly interested,
as you can tell from that photo, with moms and bumps, and also partners,
and we take what we learn from these epidemiological studies of large
populations and fold that and lots of other stuff that we’ve learned from
around the world into a world-class, co-built trial. So we design interventions that we will
use with moms and bumps and families and trial those across particularly a
Victorian context. We then have the opportunity,
which is not common amongst researchers, to take what we learned from our
randomized control trial interventions and to scale that up into statewide
translation and implementation. So at the moment, we are rolling an Infant
program out across Victoria, and Rachel Laws will talk
about that further. And as you can tell,
the fourth quadrant in the circle’s communication. As you can tell, by doing webinars and
many other things, we’re very keen that the people who are interested in the work
we do get the opportunity to hear about it. So it’s my great pleasure to introduce two
of our stars within our panel. Firstly, Jazzmin Zheng,
who’s an accredited practicing dietitian. She’s also a nutrition epidemiologist. She does…crunches the numbers to help us
understand better what it is around behaviors in early life and diet in
early life that’s going to predict health across life.
And also Dr. Rachel Laws, another practicing dietitian,
a…one of our senior lecturers within the School of Exercise and Nutrition Science,
and a great talent in helping us work to design trials and to translate them
into the community. So first thing today,
we’ll be talking with Jazzmin. So I’ll hand it over to
Dr. Jazzmin Zheng. – [Dr. Zheng] Hello, everyone. I’m Jazzmin, and Rachel and I are very
delighted to be here today to talk about childhood nutrition
and obesity prevention. And this is the overview
of our talk today. So I will start off by providing some
background on obesity and early nutrition and present some recent findings from a
Victorian cohort, and I will then highlight guidelines…some guidelines and
recommendations towards the best practice, infant feeding. And Rachel will then give a
outline on some evidence-based practical programs and
resources available for parents and health professionals to support healthy infant
feeding and active play, and she will then wrap up by providing you
with more information and references. So some background on overweight and
obesity in Australia. So high and rising prevalence of
overweight and obesity is one of the main…greatest public health concern in
Australia, and the recent estimates from the Australian Health Survey
indicates that in 2017 and 2018, that 25%, almost 1 in every 4 children or
adolescents were overweight or obese. And the figures were more alarming in
adults, that 67%, almost two-thirds of the adult population, were
overweight and obese. And what we see is a major risk factor for
a range of adverse health outcomes, including cardiovascular disease,
type II diabetes, and even certain cancers, etc. Understanding the earlier origins of
obesity is imperative for obesity prevention as obesity risk begins from
infancy and it tracks through life course. And children with overweight and obesity,
they are more likely to be obese…overweight and obese in adulthood,
and extensive evidence suggests that rapid growth during infancy is a potent risk
factor for obesity later in life. So our recently published systematic
review, we tried to summarize the literature on infant rapid weight gain,
defined as crossing a centile line in weight growth charts. So this is what a weight
growth chart look like with all the centile lines. Amd the association with
overweight and obesity later in life. And a summary of the instances from 17
eligible studies, we found they are 3.17 times more likely to be overweight or
obese in later life. And further analysis,
looking at earlier rapid weight…period of rapid weight gain from birth to one
year is particularly even higher. We’ve got overweight…subsequent overweight
and obesity. And nutrition in early life determines
growth and influences later obesity and health outcomes. Infant feeding practices,
including breastfeeding versus formula feeding,
has strong protective effect on growth and adiposity. In contrast, early introduction of solid
foods has been associated with high obesity risk. And early dietary intake,
such as macronutrient, is also important and has a significant
impact on growth and body weight status across life. And there has been a huge debate around
protein intake during infancy and early childhood in promoting rapid growth and
obesity, and in particular, the high-protein content in formula
compared to breast milk has been much debated. Furthermore, intake of specific foods such
as sugary drinks and energy-dense and nutrient-whole foods has also been
associated with obesity. And given that dietary behaviors and food
preferences are established early in life, infancy and early childhood provides a
unique and sensitive period for obesity prevention. So now I’d like to share some of the
recent findings we found from a Victorian cohort called the “Melbourne Infant Study”
consisting about 500 children before until 5 years of age. And Rachel will talk about the Infant
study itself later on. So by using the Infant data,
we addressed two main research questions. So the first one is to look at infant
behavior, including breastfeeding duration and the timing of solid introduction,
how these two factors are influencers, the body weight trajectories from 1st to 5
years in early childhood. And given the hot debate around protein
intake during infancy, we also examined the association between
total protein intake and protein sources during infancy and how it relates to body
weight standards at 5 years of age in early childhood. And in both analyses, we use four…
we look at body mass index z-scores. So BMI z-score is a measure of weight
standards accounted for age and sex, and it’s a value we use in monitoring
growth and body weight development in children. So these slides here are showing you the
relationship between breastfeeding duration and growth trajectories
in early childhood. So we divided the sample into two groups
by breastfeeding duration, children in six months versus
six months or more. So the graph shown in here are the
trajectories, the BMI trajectories from birth to 60 months, so 5 years,
by their breastfeeding duration. Oops. And the trajectory curve are plotted from
one where we adjusted for a range of child and maternal factors associated with body
weight development. So they are child birth weight, child sex,
gestational age, the maternal country of birth, maternal education levels,
so as a proxy for socio-economic status, and you also have mother’s pre-pregnancy
body weight status. So from the graph, this graph here,
we can see the dotted line with triangle markers. They represent the growth trajectory,
so the BMI z-score of children who started…who were breastfed for shorter
than six months. And the black solid lines represents BMI
trajectories of children who were breastfed for six months or more. So we can see there no difference in BMI
z-score at birth between two groups. However, interestingly,
we found from 3 months to all ages to 60 months, children who were breastfed
for 6 months or more, indicated by the black lines,
they had a significantly lower BMI z-score than children who were breastfed shorter
than 6 months of age. And the gap between the two groups is
particularly evident at six months of age. So we conclude that these long-term
protective effects of breastfeeding on overweight and obesity extend to
five years of age and is independent of childbirth weight,
mother’s country of birth, educational level, and also pre-pregnancy
overweight status. So these provide further support for
infant feeding guidelines to promote breastfeeding for six months or more. And this slide here is showing us the
results which…of timing solid introduction in growth trajectories in early childhood,
and similarly, we have also divided the group into two groups by the timing of
solid introduction before six months versus at or after six months. And the dotted line with triangle markers
are showing BMI z-score trajectories from birth to 60 months of children who
started solid before 6 months, and the black lines here are showing the
BMI z-score trajectories of children who started solid at or later than 6 months. And surprisingly, we found children who
started solid before six months, they had a higher BMI z-score at birth. So that means children who are heavier at
birth, they are more likely to be introduced to solid earlier,
before six months. So what does that mean?
Does that mean large makes more hungry? So it is likely that heavier babies,
they are more likely to show an earlier sign of readiness, but however,
further evidence are required to test this. And when we look at the BMI trajectories
between the two groups from 3 months to 60 months, we found there is no
difference between the two groups, in particular, there’s no difference found
in BMI z-score at 6 months of age. So this is consistent with the current
body of evidence regarding timing of solid introduction and obesity risk. So there is no evidence of association
showing that introduction before six months with higher obesity risk. However, there is some evidence showing
that early introduction, before four months,
and higher obesity risk. However, testing the impact of early
introduction before four months on growth trajectories is not feasible in the
example because only 2% of the children, they introduce solid before four
months of age. However, it will be valuable for future
studies to examine this. So taken together with the findings from
breastfeeding duration, we can conclude that the timing of solid
introduction, whether before or after six months, was less important in
predicting growth trajectories than breastfeeding duration. And we then looked specifically into
protein intake and sources at nine months. And so we [inaudible] for the example. So we found the average of the protein for
this cohort is 28 grams per day and is all meeting the adequate intake for this
sample of 14.4 grams per day. And when we look at the breakdown of
protein intake by different sources… …and you can see more than half came from
plant and animal, indicated by the green and the yellow, and then the other half
came from breast milk formula and dairy, and in which, formula is the largest
contributor, contributing about 24% of total protein intake. And we then conducted an analysis to look
at the association between total protein intake and their sources at nine months in
relation to BMI z-score at five years of age. So these slides are showing you the
association between total protein intake at nine months, so BMI z-score
at five years of age. So we categorized the sample into four
protein intake groups based on their intake distribution,
so with mean intake of 16, 23, 30, and 41 grams per day respectively. And by looking at…using the highest intake
category of 41 grams per day as a reference category, we are trying to see
how do the rest of lower-intake protein categories associate with BMI
z-score at 5 years. And the asterisk here indicates a
significant difference between the reference category of the highest protein
intake group and the comparison group. So we found the group with the lowest
protein intake group with 16 grams of protein per day was associated with a
lower BMI z-score of 0.3 units. However, this was
not significantly different. In contrast, the second and the third
protein intake group with mean intake of 23 and 30 grams respectfully,
they are all significantly associated with a lower BMI z-score at 5 years when
compared to the highest protein intake group. And in particular, the second intake group
of 23 grams was associated with the lowest BMI z-score at 5 years. And if we test for trend,
there is no linear trends. So there was a U-shaped relationship
between protein…the protein intake and BMI z-score at 5 years of age. And so that means neither too low nor too
high is beneficial for child growth. So [inaudible] more intake of
total protein of 23 grams that’s most beneficial for child growth. We then look at different protein sources
and how it relates to BMI z-score at five years of age, and similar findings were
found for animal protein but not other protein sources. So with our second intake group,
with three grams of protein intake, was associated with the lowest
BMI z-score at five years of age. A U-shaped relationship was also revealed. So we found an optimal intake of total
protein and animal protein intake for child growth, and the finding of this
study is particularly valuable for informing the establishment of
nutrient reference values for optimal infant protein intake. However, because the infant sample have a
higher proportion of the children, they have mothers of high…highly educated
mothers, so further research in different study [inaudible] relations is
needed to consolidate these findings. So after we have been through all the
interesting findings from the real Victorian data, now we can link this back
to guidelines and recommendations. So for breastfeeding,
the Australian infant feeding guidelines support, promote,
and encourage exclusive breastfeeding to about 6 months of age and continue
breastfeeding until 12 months of age and beyond. And any breastfeeding is beneficial for
the child and the mother. And when the child does not receive any
breastmilk, parents are advised to choose formula with the lowest amounts of
protein, closer to 1.3 grams per 100 mil. And to make sure we ensure correct
preparation as per instructions by using the scoop provided and divide the amount
of water, and also follow the baby’s hunger cues and not the clock,
and try to phase out the bottles by 12 months of age, introducing a cup. And Rachel and our team recently wrote a
conversation article specifically about formula feeding entitled “If you are feeding with formula,
here’s what you can do to promote the baby’s healthy growth.” So you can have a further read
if you are interested. And for solid introduction,
the infant feeding guidelines recommends introduction at about six months of age by
introducing iron-rich food first to prevent iron deficiency,
such as iron-fortified cereals and pure red meats
and poultry, legumes, and beans, and also avoid juice, and sugary drinks,
and all foods with added sugar, and also limit nutrient-poor and
discretionary foods such as cakes, and biscuits, and potato chips,
and also feed to appetite, and parents, that they should provide, and baby,
that they should decide how much to consume. And from 12 months of age,
children are encouraged to have family meals consistent with the Australian
Dietary Guidelines and choose the foods from the five core food
groups shown in here. So we can see there the grains,
vegetables, fruits, and milk and alternatives, and meat and
alternatives, and also avoid discretionary foods high in saturated fat, added sugar,
added salt, and alcohol, which is down the corner here,
showing some examples. And the Australian Dietary Guidelines also
provide sample data for parents with infants aged 7 to 12 months and also
for toddlers 1 to 2 years, and they provide the recommended amount
from each five food groups by providing the standard serves and also the number of
servings per day. And just to be aware that the serve size
for infants aged 7 to 12 months are smaller than those for
toddlers 1 to 2 years. And then for children two years and older,
Australian Dietary Guidelines also provide similar information on the recommended
amount from each five core food groups. And by providing the serves and then
standard serves based on your age and sex… And they, in addition,
they also provide graphical examples of what constitutes a standard serve. And given our time, so I won’t go through
all the details here, but all the information here are available
on the Australian Dietary Guidelines website, and you can go online
and check these out. And now I will hand over to Rachel to talk
about practical programs. Thank you, everyone. – [Dr. Laws] Thanks very much, Jazzmin. I’m delighted to be here to discuss some
of the practical programs that we’ve developed here at the Institute for
Physical Activity and Nutrition with the team, and to really, I guess,
showcase to you how we’ve translated some of this research around nutrition and
epidemiology into kind of practical programs to support parents. And it’s fantastic that we’ve got so many
parents online here today, and hopefully, you’ll be able to take away something from
this session around our practical programs. So I firstly wanted to go through a
program called the Infant program. As Jazzmin has already alluded to,
it was developed by Karen Campbell and… who you’ve just met, and
Associate Professor Kylie Hesketh. So Karen has obviously an interest in
nutrition, Kylie has an interest in active play in young children, and together,
they conceived this program, which really aims to improve both child
and maternal diet, physical activity, and sedentary behaviors. And there’s a real focus on increasing
fruit and vegetables and water, and reducing some of those discretionary
foods which Jazzmin has just been talking about. So it was a program that was developed to
be delivered through first-time parent groups here in Victoria. So all the parents online,
you may remember going to a first-time parent group with your first child. So the program was actually delivered
through those groups over the first 18 months of life. So it started with parents with babies
about 3 months of age. It went up to 18 months of age. And there were essentially
six group sessions. Sessions ran for an hour to an hour and a
half, and we really facilitated group discussion by providing some information
to parents in an anticipatory guidance way, which really means providing
information before parents actually need it. We had a lot of group discussion around
how parents could practically implement some of these recommendations
with their babies. So Karen and Kylie actually ran a
randomized controlled trial to test the effectiveness of this program in 14 LGAs,
and I just wanted to give you an overview of some of the results of the program and
then tell you a little bit about how we’re implementing the program going forward. So the RCT involved just over 500
mother-and-child pairs, and I’ll show you the results
of those in a moment. But just to reflect on some of the key
messages that were coming out of the Infant program, so you can see the
messages on your screen there. So they were around a focus on fruit and
vegetables, both in snacks and in meals, but also around tapping into water,
role modeling around eating together and playing together, and also an important
message around parents provide, babies decide or children decide. And Jazzmin talked about that briefly. So that’s really around a parent’s
responsibility is to provide regular healthy meals and snacks and it’s really
up to babies or children to decide if and how much they’ll eat. And all the parents online will know that
the kids are very good in deciding if and how much they eat but us parents are
probably less good at letting our kids decide. So take the pressure off and leave it up
to your children to decide if and how much. They’re very good
regulators of their own appetite. Another really key message coming out of
the Infant Program was the Off and Running. So that refers to switching off your
screens, the TV, and getting your children physically active, ideally outside. So that was kind of the key messages that
were reiterated through those six sessions that parents attended. So just looking at some of the outcomes
from the randomized controlled trials, so starting with the outcomes for the
moms… So firstly, moms told us that they really liked the program. So we had over 70% attend more than 4 of
those 6 sessions over that 15-month period. And also parents told us that they found
it useful, and indeed we saw improvements in parents’ knowledge, their confidence. We saw changes in the feeding practices in
a positive way. And really interestingly,
we also saw changes in mom’s dietary patterns. So even though the program typically
wasn’t focusing on what moms were eating, we actually did see improvements in
maternal dietary patterns. So this really indicates that moms were
really role-modeling some of those positive messages to their babies. Looking at the child outcomes,
this is at 18 months, so we found that children watched around
25% less television than those in the control group. We also saw about 25% fewer sweet snacks
being consumed and an overall improvement in the diet quality of the
children at 18 months. We also saw in some subgroups,
so particularly in younger, less educated moms, that their children
were also drinking more water and eating more vegetables, which
is really encouraging. However, we didn’t see any impact on child
growth than we expected. We probably need actually much larger
numbers in order to see that kind of impact on growth trajectories. What was really encouraging was that these
children were also followed up until they were three and a half and five years. So we were able to see that some of those
positive outcomes were sustained, in particular that children continued to
consume fewer sweet snacks in the group that got the program. They also consumed more water at three
and a half years, and really importantly, consumed less sugar-sweetened beverages at
five years, which is fantastic given that it’s such a low-dose program,
and five years later, we’re still seeing some of those
behavioral outcomes being maintained. They also viewed less TV at five years,
which approached statistical significance. As you would expect,
we didn’t see any change in growth at 18 months. We also didn’t see any differences in
growth trajectory at those later years as well. So what’s happened to the
program since then? So the RCT, I think,
was about 10 years ago, and since then, we’ve had some opportunities to implement
the program in the real world as part of the Healthy Together Victoria
initiative, which some of you may be familiar with, which ran a few years ago. So there were a number of communities that
received special health promotion funding. So the program was made available to those
communities as a healthy living program, and we did see that 8 of those 12
communities did take up the program and started running it in their communities,
which was fantastic. And since then, we’ve actually secured
some funding to look at a statewide rollout of the program,
which is really exciting, and that’s through an NHMRC partnership
grant, and you can see the list of wonderful investigators
down the bottom. Essentially, we’ve got funding to evaluate
the implementation of this program across the state of Victoria. And we’re really excited to have 10
practice and policy partners on board, which you can see on the screen there,
including Victoria Department of Education and Training, the Department of Health and
Human Services, and also VACCHO. So we’re looking at developing an
Aboriginal-tailored resource as part of this program as well. So what next with the rollout of the
Infant program? So basically, we’ve been working very hard
over the past six months to develop up some of the systems to roll out the
program across the state, and essentially, it’ll be made available to local
government areas next year. We’re developing online training programs
with facilitators who are interested in delivering the program,
and we’ll be supporting them through our communities of practice. And the program will then be rolled out
and delivered in local government areas that choose to take it up. And our role as researchers is really to
understand how the program is being implemented, so who we’re actually
reaching, what is the adoption and uptake like at the local government area,
how is it being implemented, and importantly, what will be the effect
of the program on parent and child outcomes after five years. And of course we’re very interested in
feeding back those learnings back into further improving the program. I also wanted to talk to you about another
related program called My Baby Now, which is an app, and we designed it. We’ve been working on it over the last
five years or so now, and the team of people involved in
developing that, you can see on the screen. But we’ve got a strong team of people,
including Professor Elizabeth Denney-Wilson
from University of Sydney, and a group of us here at Deakin and other universities involved in
developing that program. So essentially, it is an app and website
resource that will provide a key source of support for the face-to-face program
that’s being delivered through Infant. And the app is based on an extensive
formative testing of a previous version of the app called “Growing Healthy,” but
we get input from about 300 parents and a whole host of maternal and child health
nurses, which is fantastic. We have Raising Children Network as key
content partners in the app as well, and the aim is to have the app available
across all devices, and tablets, and desktop, so there’ll be universal
access to the program. And we’re looking to make the program
available to those who are participating in the Infant rollout starting next year. I wanted to give you a bit of a tour of
what was actually included in the My Baby Now app. So just in terms of what the focus of the
app is, it does focus on, I guess, all of the components of the Infant
program, but it does include a focus on breastfeeding. And if breastfeeding is not possible,
it also includes a focus on best practice formula feeding. There’s content around introduction of
solids, healthy infant feeding practices. There is information on recipes,
limiting exposure to non-core food and drinks, and there’s also a section on
play and pregnancy. So importantly, this program actually
starts in pregnancy so we can really support parents with those early stages of
feeding, in particular breastfeeding. So just to take you on a quick tour of the
app… So there’s a My Baby section, which is really like a newsfeed or an
update section where parents will get push notifications. So we’re sending three push notifications
a week, and these are tailored to both your baby’s age but also
baby’s stage of development. So My Baby will send you messages that are
just right for the sorts of things that you’re considering at the time. And you can see there some feedback from
one of our pilot participants, and they told us that, you know,
“The app, it’s just so accessible. It’s right there on your phone. And you’re thinking ‘What shall I do?’
you’ve got the information right there.” So that’s the aim is to give you that
information as you need it. So there’s a whole series of topics within
the app, and within each topic, there’s a series of articles,
which hopefully will be of interest to parents. So within the articles,
we’ve got text information. We’ve also got lots of videos and pictures
to make the information accessible to a wide range of audiences. We also have a Tools or an Activities
section of the app, and these are quizzes that you can do to get immediate feedback
on aspects of feeding. So, for example, is your
baby ready for solids? If you’re not sure about that,
you can do the quiz. You’ll get some immediate
feedback on that. And you can actually click on some of that
feedback and…to look into the other sections of the app. So basically from here… So as I mentioned,
the Infant program will be made available to all the LGAs across Victoria,
and it’s starting next year, and the My Baby Now app will be offered to
people who are participating in the Infant program. We’ll be evaluating the effectiveness of
that…those programs over the next five years, and we’ll also,
as I mentioned, be working with VACCHO to develop a program of work to develop
and adapt resources specific to Aboriginal families. If you are working in an LGA and you’re
potentially interested in facilitating the Infant program, Karen would
love to hear from you. And we’ve got Karen’s email address there,
so please get in contact with Karen if you’d like more information about the
Infant program, particularly if you’re interested in being a facilitator. And also we’re at the stage with the
My Baby Now app where we’re actually doing some technical testing of the app. So if you’re a parent and you’d love to
have a look at the My Baby Now app, and you’re happy to do a bit of testing
for us and give us some feedback, then please get in contact with myself.
I’ve got my email address there. We’d love to have your help with that. The last practical program that I wanted
to tell people about was the free online course that we had for parents
and health professionals. So this is a FutureLearn course called
“Infant Nutrition.” And as the title suggests,
it’s really for breastfeeding right through the baby’s first solids and family
food, so that first year of life. So this was developed by Karen Campbell. We’ve had input from another…a number of
researchers and experts in infant nutrition here at the institute. And the next course is running on the 29th
of July, so completely free. If you google “FutureLearn” and “infant
nutrition,” you’ll be able to find that course, and you’ll see that we’ve had
several thousand people actually complete the course over the past couple of years. So if this is an area that you’d like to
do a deeper dive on, then please join us for the next course on
the 29th of July. So that’s the end of all of the content. I just wanted to alert people that
they’re…if you’re interested in more of the academic publications,
there’s a list of related references both from Jazzmin’s work but also from the
Infant program and from the Growing Healthy and the My Baby Now program of
work. So please feel free to have a look at any
of those references and of course get in contact with us if you have more
information or questions. And now we’re going to move into our
question time. – We will. Thank you so much for such an insightful
presentation, Jazzmin, Rachel, and Karen. I appreciate all of you being here.
We’ll just squeeze in. – Let’s squeeze around the microphone.
[inaudible] – So I’ve had a look at the results from
the poll that we put up at the start. And we’ve got a significant majority of
health professionals joining us today, more than…much more than 50%,
but there are some parents, and students, and local government representatives, too. So thank you all for joining us during
your lunch hour, and it’s great to have you with us. So now is the time to write any of the
questions you have for our presenters into your question box
and then hit Submit. We’ve got a few who…that have come through
already, so I think we’ll just get through as many as we can. To start with, Jazzmin,
I think this refers to the…your section at the start. Rita has asked if you referred to solely
breastfed or receiving any breast milk. I imagine that might be the
difference you were talking about between breastfed versus formulas. – Yes, what I’m trying to say is
that breastfeeding has strong protective effect compared to formula feeding. – And would that be if they’re receiving
any, a bit, or most [inaudible]? – Yes.
Actually, any breastfeeding is beneficial. And when all the analyses that we have
done, including people that they have been breastfeeding… So to measure exclusive
breastfeeding, it’s quite hard. So in our analysis…so we included anyone
who had any breastfeeding. Yeah.
– Right. Right. I can squeeze across a bit,
and you can squeeze in a bit more Karen, if you’d like.
We’re getting very cozy here. So the next question we’ve got comes from
Colleen, who asks, “What should parents be looking for in protein levels of formula?
Is it less than 1.2 grams per 100 mil?” [inaudible] – Sure. So in Australia, the regulations around
protein levels of formula are somewhere between 1.2 and 2 grams per 100 mils,
so what we’re suggesting is that parents choose protein levels at the lower
end of that range. So we know breast milk has around
1 to 1.1 grams per 100 mils. So we’re suggesting that if you choose to
the lower end of the 1.2-to-2-grams-per-100-mil range,
then you’ll get a closer match to breastfeeding. – Okay. We’ve got a couple of questions about the
My Baby Now app, but firstly, Karen, could you just repeat the email address to
email if people want more information? Sorry. Rachel. – No problem. So if you’re interested in helping us test
the My Baby Now app, my email address is [email protected],
the one that’s on the screen on the left-hand side. You email me,
then I can send you the information. We’d love your help with testing. – And Chelsea was interested to know what
ages of the child the app is targeted at. – Great question. So it’s right through from pregnancy,
so early gestation through to 12 months of age. – All right. There’s a question from Ella
here who works in homelessness. She asks, “Any tips on how to promote
health and nutrition for families who cannot afford much?”
Who would like to take that one? – Who wants to tackle that one? – Well, that’s a really great question,
and because there’s all sorts of barriers around buying, and preparing,
and affording, and keeping food. I guess, at the start,
really asking them to be able to do is to breastfeed because
breastfeeding is cheap. It’s cheaper than formula feeding, and,
in fact, you need very few additional nutrients, surprisingly,
to be able to breastfeed successfully and still remain healthy yourself. We know also breastfeeding confers some
health benefits onto the mother as well as the baby. I mean, I haven’t given this deep thought,
but that’s an area that’s really important to consider, and I think I would be
considering very carefully the services that are around to support people who are
struggling and finding it hard, I mean, in finding finances to
support their health. It makes the choice of food even more
important because if you’ve got a few dollars, choosing things that are
going to be easy, accessible, but healthy are very important,
and that’s not how the [inaudible] see it, I suspect. – I’ll just push this one back a bit and
see if we can see all the better. There we go. It’s going to be on there so we can just
squeeze in one way and answer another question. So a question for myself,
as the parent of a somewhat fussy young toddler, a fussy eater,
for us parents out there, do you have any recommendations
for fussy eaters? Dos and don’ts. – So we’re talking about slightly older
children, I suspect. – [inaudible]
– I know your baby is 19 months old. – Yes.
– So yes. Children are…become less and less
malleable as they get older. I have 25- and 27-year-olds,
so I’m well-equipped to talk about this. And I think that’s a big topic.
There’s a lot to talk about. I think the book, the FutureLearn book,
is a good place to get more detail on that. But I guess some basic principles relate
very much to the psychology of feeding children. So a line I think of myself is that the
more you play ball with whatever they’re throwing at you, the more
they’ll keep playing. So by that, I mean if your children become
increasingly fussy and resist the food that you’re having, the more that you
respond to that, the more you change the food you’re offering,
the more you go and get something else that you know they like,
the more they are likely to keep doing that behavior. So the notion of “parents provide,
children decide” is quite a nice one that Rachel has talked about, a nice,
behavioral approach. And that says, and I’m repeating what
Rachel has told us already, that, as a parent, you have the opportunity to
provide healthy food at regular intervals, so predictable intervals.
That’s your job done. The baby’s opportunity
is to eat it or not. And they might throw it on the ground,
and cry, and…or to eat it. They will become hungry,
and they’re not in great distress at this time, they’re using their new
manipulative skills, then let them decide whether they eat or not.
Let them decide how much they eat. The more you engage,
the more you play ball, the more it becomes a little bit of a
competition and a game. So as hard as it is to do, standing back,
letting your child decide what to eat and how much to eat is important,
and what to eat is really decided by you. You figure it out. I think baby-led weaning,
which we haven’t talked about, so not “baby linguine,” but “baby-led
weaning,” I think can be particularly useful here.
It’s a whole another topic. Again, we cover it off well in the
FutureLearn book, but that’s really saying lots of foods in front of the baby,
resist the temptation to feed it to them yourself, then they will take
control and eat it themselves. – But be ready for some messiness.
But it’s all part of it, isn’t it? – Yeah, yeah.
– Eating outside is good. – Great. We had a question from Ally,
who is soon to graduate. “Interested to know who the facilitator
training is open to for their Infant program.” – Do you want to
answer that? Sorry. We’re having a bit of a guess,
aren’t we? Yes. I mean, I guess at the moment we’re really
having maternal and child health nurses, but certainly within local government
areas, we have had parenting support workers run it, we have had health
promotion officers run it, we have had dietitians run it. So I guess we’re not wanting to limit it
down to a particular health professional type, but I guess we’re
trying to test what different models of delivering the program might look like. So we’re really open to other health
professionals potentially running it, and obviously, it’s provided with,
you know, a whole lot of training to support facilitators in
delivering the program. And I guess what’s come out of our early
evaluation of the role at…in other local government areas, if people feel
comfortable in delivering parenting programs generally, then they’re generally
comfortable after the training to deliver these type of programs. So hopefully that gives you a bit of a
sense of we’re fairly open to… – Yeah.
– …to [inaudible] delivery. – I think one proviso at the moment given
that this is a community trial and our interest is to promote healthy eating and
active play knowledge and skills to everybody, not just to people who could
afford it, this…that this is something that will be offered really free through
communities. So local government areas both pay a small
amount for the training, but at the end of the day,
the delivery of the program will be free. – And is the program confined to Victoria
at the moment? And do you look at going outside?
– Yes. [inaudible] at the moment, it is,
but the grant that we’ve got from the National Health and Medical Research
Council has included nutritionists and dietitians from all jurisdictions
around Australia. So I guess what I would say is that we’re
hopeful that any of the lessons that we learn, and this is unusual kind of
research, the translation research, may be useful in other
states and territories. So there’s a lot of people watching this
space at the moment. I think it’s just universally been
acknowledged that what we do in this pregnancy, first days of life,
first years of life, is fundamentally important to health
across the rest of your life, so let’s work hard to get it right. – Another question from Ella came in. She asks, “Do you know or think that
there’s a correlation between children choosing not to eat foods because they are
intolerant or allergic and maybe it causes them pain?”
Anyone want to tackle that one? – I’ll [inaudible] about it. Yeah. That’s a really good question, Ella,
and I think we…we can’t answer that definitively one way or the other because
we’d have to know these children. Or without testing…
– [inaudible] – …changes in their guts,
how would we definitively know that? I think we probably shouldn’t give too
much credence to that because I think a lot of what’s happening with fussy eating
is behavioral manipulation on the child’s part, notwithstanding that
actually given that we have a well-acknowledged and quite large treasury
of children who are on the autistic spectrum and some children with real
developmental [inaudible 00:43:42], it is important to differentiate or break
apart children…the mass of children who are just having a go with their parents
and seeing how much weight they can pull and children who have special needs and
may indeed be much more sensitive to taste, and sound,
and the whole range of things. So, again, on our FutureLearn course,
we have a section on fussy eating generally, and we have one on
extreme fussy eating. You might like to have a look
at them in the future. – We clearly only have a bit of time now,
so I encourage everyone that’s been sort of…anyone that’s been sitting on a
question to please type it into the question box now and hit Submit. We’ve got, yeah, a little bit of time left
for some more questions, and thank you to those who’s already sent
theirs through. I’ve got another one, which is,
again sort of from my mind. So I’m just wondering if there are any
resources the three of you recommend for…recipes for, you know,
young children that are sort of both popular with kids but also very healthy,
that kind of thing. – Well, if you want to help us test the
My Baby Now app, we have a whole recipe section in there which is specifically
designed for family meals but can be adapted for babies and for toddlers. So there’s nothing worse than kind of
trying to think that you’re going to cook different meals for a toddler,
and then something else to feed the baby, and then something else for the parent. So these recipes are really designed to
cover off a whole host of options for feeding the whole family. – So a very good reason to dive into the
My Baby Now app and do some active research with us and help us to get it
right. I think one of the things in some research
I did a little bit in the past was looking at children’s salt intake. And of course we know that salt’s not
right for any of us. Salt intake in very young children,
so children who are moving to the family meal, is actually extremely high. And so when thinking about meals that are
healthy for kids, we would encourage family meals, but the premise has to be
that the family meal is a healthy meal. And so one of the things we’re really
conscious of is not adding salt to your cooking, also being aware of all
the hidden salt that’s set into your cooking. So, for instance, choosing a lot of salt
stock if you’re buying stock and not the regular stock, being aware that some
brands are much saltier than others, that some brekky cereals are much saltier
than others. So when we have children, they come in,
they catastrophize our life. We were talking about this over lunch. Who would know how amazing it is to have a
child and how much time they take up? But they will join you at your table,
we hope. That’s the best place for them to be
eating is with you and your partner. But it’s a great time for you to start to
model the healthy behaviors you know that you should be embedding yourself and to be
aware of, you know, all the health messages that are good for you may be good
for your baby. – Great. And Karen, you were mentioning when we
were discussing the needs of… and children with special needs, Lauren asks,
“What was the course that you said had information about feeding in children
with special needs, e.g. ASD?” – So that’s a section called “extremely
fussy eating” and that’s within the FutureLearn [inaudible] book and
online course, which Rachel referred to. So if you want to do that
course, it’s free. It’s run by us at Deakin,
and it’s run four times a year. The next start date is the 29th of July,
I think we said. We’ve actually just finished one. If you just Google “FutureLearn” “infant
nutrition,” you’ll find that it comes up, and you can register,
and then you may get a reminder email to join as it starts. – Great. Thanks. Okay. There’s one question here from Tony,
so I’ll read it out and see who would like to take that one. “Regarding formula feeding,
although we intend on breastfeeding, is it recommended to choose formula based
on lower protein levels to avoid obesity?” And he says, “We’re expecting a second
child soon, and our initial thoughts were to avoid one of the popular formula types
just to avoid the no stock issue that we see at supermarkets.
What are your thoughts?” – Yes. I guess if you’re intending
to breastfeed, then I guess that’s a fantastic intention to go with.
In terms of formula choice, yes. So choosing a formula with the lowest
amount of protein is what we’re recommending. So have a look at the various options
available in the supermarket. And there is an overwhelming number of
options, but it does provide you with some guidance on which one to choose. – Right. Thanks. Now, Dale’s bringing in a question or a
comment, saying, “It is interesting that the two key messages are around fruit and
veg for the Infant program when mothers often find these foods easy to offer as
first foods but find meat and alternatives, i.e. iron-rich foods,
harder to know how to introduce.” Any thoughts on that? – Yeah. Look, it’s a great question.
Do you want to jump in, Jazzmin, or…? – Okay.
Yeah, I think you’re right. We’re all pretty good at knowing how to
purée up some fruit and vegetables, but thinking about how you actually get
iron-rich foods in is really important, and the infant feeding guidelines do
recommend the introduction of iron-rich foods as first food. So I guess looking at iron-fortified
cereals is a good way to go, so [inaudible] rice cereals. Weet-bix can be quite
high in iron as well. And you might also be thinking about
including some puréed beef, or lamb, or other meats high in iron as part of
baby’s first foods as well. So that can be either done through some
puréeing and mashing with other foods or it could also be done through some
baby-led weaning approaches. So babies are quite good at even sucking
on a piece of steak and getting quite a lot of nutrients out of that even if
they’re actually not able to chew it at that point in time. – Can I intimate something? Things like meat steak are actually quite
good because it really is mostly just meat. Whereas the foods, the
[inaudible] foods we know are often offered as sausages and fish
fingers, which actually are not very high in iron, and the reason… I mean,
it is a great question. The reason we provide iron is because iron
is one of the [inaudible] nutrients in children’s diets in Australia
and around the world. So it’s just one to keep in mind. It’s not one to become obsessive about,
but it’s one to keep in mind. – Another question here from Ella,
who’s been great. Thank you, Ella. So, “When breastfeeding,
how important is mom’s nutrition? If mom isn’t eating well,
will that significantly impact the quality of their milk?” Then she is thinking again about
homelessness, the homelessness situation. – Happy for me to…
– Yes. – So, it’s, again, a lovely
question, Ella. Thank you. I mean, one of the interesting things with
breastfeeding is that the quality of breast milk is maintained at a very
high level and even in extreme malnutrition,
so as we might see in developing economies. So the body preferentially will nourish
the baby over the mother, and I guess that’s to do with, you know,
adults can probably survive for a while being less well-nourished. A child definitely can’t because they’re
in such rapid growth and development. So notwithstanding that,
babies will do well. But mom’s nutrition is incredibly
important for their own health. It’s one of the risks for women when they
have babies is that they gain weight more rapidly than they would have done if they
hadn’t. And the heavier they get,
the worse their own health outcomes will be over life. It’s very hard to lose weight once you
gain it, so keeping an eye on your own weight when you have a baby
is very important. And I guess one other comment is that the
food that you eat as a mother, probably during pregnancy but also while
you’re breastfeeding, does convey flavors across to the
embryotic fluid in the…when the baby’s in utero, but also to the breast milk when
the baby’s breastfeeding. And there’s new and emerging evidence that
would suggest that mothers who, for instance, enjoy more fruits and
vegetables…. Let’s use vegetables in particular because
that’s one of our most limiting foods. …enjoy more vegetables when they’re
pregnant and when they’re breastfeeding have children who will be more accepting
of those foods when they’re introduced. – All right. Oh, we’ve got one last question here,
and then I think we’ll have to finish up. So Chelsea asks, “Do you take into
consideration environmental sustainability eating for planetary health of diets and
foods in your recommendations?” – Yeah, absolutely. I think that’s a really
great point, Chelsea. And we’re hearing, I guess,
more and more with the EAT-Lancet report that’s come out earlier this year around
the importance of not only eating for our health but also eating for environmental
sustainability and the planet. So I guess both recommendations are really
suggesting a kind of flexitarian-type approach to eating. And we’re not just having a very
meat-based diet. We’re having much more of a
vegetable-based diet and getting a lot of our proteins from vegetables. So we translate that back to what we’re
introducing our babies to. And thinking about introduction of solids,
then legumes are a great source of iron. So thinking about where we can incorporate
legumes and plant-based proteins, tofu, soy-based proteins, into
the diet is fantastic. So I’m thinking of some wonderful
vegetable casseroles with legumes that you could introduce your babies to,
which would also be great for the planet as well as for the whole family’s health. – Kind of [inaudible], I imagine.
– Yes, absolutely. Yeah. – Oh, well. That’s great. That’s all the time we have for the
questions. And thanks to everyone. And please feel free to email through any
questions you have after this to the email address that you see on the screen. And thanks to the three of you for your
time today. It’s been fantastic to have you. So Professor Karen Campbell,
Dr. Jazzmin Zheng, and Dr. Rachel Laws, thank you very much. – Thank you.
– Thanks. It’s been fun. – So I’m going to turn the whole camera
off for a second. There’s a few more messages I have got for
you from the Alumni Relations office. So just to let you know,
please don’t forget to follow us on social media. We’ve got Facebook and LinkedIn channels,
and we’d love to have you connected with us. So as a part of that,
you’ll hear about events that we’re running and also great offers like this
one, which is 15% off postgraduate course fees for Deakin alumni and immediate
family. You can find more information about that
on the Deakin Alumni website. Another thing that we love to do for our
alumni is provide some great competition opportunities. So if you do provide us with your contact
details or stay in touch via social media, you will hear about some of these
fantastic competitions. And you can take away some great prizes
like tickets to Netball games or movie vouchers and some travel vouchers as well. So please do keep in touch with us. So that’s all we have time for today. Thank you again for joining us,
and thanks for all the questions. We hope you can join us for the next
alumni webinar, which will be coming up soon.
Have a great day.

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