Abstract
Objective: This paper aims to establish a potential reference standard for the process of transition from milk to solid food in infants and preschool children in Japan, using the transitional food process (TFP) scale described by Sakashita et al. The background for variation and delay in the process are also discussed.
Design: A randomized sample survey covering entire Japan.
Setting: Mailing self-completion of questionnaires.
Subjects: Randomized sample of 14 000 children aged 0–6 y and their family from 13 prefectures in Japan, namely Hokkaido, Aomori, Iwate, Niigata, Tokyo, Saitama, Fukui, Nagano, Nagoya, Hyogo, Yamaguchi, Kagoshima, and Okinawa.
Methodology: Questionnaires requesting the TFP scale and background factors were sent to 14 000 children and families. The percentile ages were calculated. An eating ability index (EAI: number of accepted foods/total number of foods) × 100) was calculated. Regression analysis by analysis of covariance (ANCOVA; SPSS, 1997) was used to determine the influence of background factors on EAI.
Results: From the 6747 (48.2%) effective answers received, percentile curves of the acceptability of each food on the scale were drawn, and used as initial reference standards. The 50 percentile age range of these 20 standard foods covers from 5 to 42 months after birth. The sensitive period for increasing the acceptance of foods in children was between 6 months and 2½y of age. ANCOVA regression model (R2=0.605) showed that EAI was mostly influenced by age (P=0.000), followed by feeding style (P=0.000), infant food preparation (P=0.000), information source (P=0.000), and birth order (P=0.003). The dominant cause of digestive system problems was shown to be infection, not too-hard food. It seems that breast feeding, bottle feeding with chewing-type nipples, and the manner of preparing infant foods from the family table promote the progress in acceptance. Children whose mothers followed the information given in books or magazines showed a slower progress.
Conclusions: It seems appropriate to use this reference standard in the study of the transitional process from milk to solid food in infants and preschool children in Japan.
Sponsorship: Grant-in-Aid for Scientific Research, provided by the Japanese Ministry of Education, Culture, Sports, Science and Technology Project No. 07838030.
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Acknowledgements
This research was supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology in Japan, No. 07838030: a study on the developmental assessment of masticatory system in children from the aspect of morphological, functional, and behavioral development.
We express our sincere appreciation for the cooperation of the mothers of children studied. We are also indebted to the directors, public health nurses, and staff of public health centers in each district for their kind cooperation, support, and understanding of the authors’ aims. Finally, we thank Ms Veronica Hunt, Natural History Museum, London, for linguistic advice and comments on this paper.
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Guarantor: Reiko Sakashita.
Contributors: RS participated in the study design, collected the data, carried out the statistical analysis, participated in the discussion of results, and wrote the paper. NI participated in the study design, coordinated the study, participated in the discussion of results, and reviewed the paper. TK coordinated the study and participated in the discussion of results.
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Sakashita, R., Inoue, N. & Kamegai, T. From milk to solids: a reference standard for the transitional eating process in infants and preschool children in Japan. Eur J Clin Nutr 58, 643–653 (2004). https://doi.org/10.1038/sj.ejcn.1601860
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DOI: https://doi.org/10.1038/sj.ejcn.1601860
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