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Déterminants des pratiques de diversification alimentaire des enfants de l’étude ELFE : données de santé, caractéristiques socio-économiques et démographiques familiales, croissance précoce de l’enfant.

Abstract : Infant feeding practices could be risk factors for cardiovascular diseases, via early nutritional programming. These practices have not been described in detail in France until now and knowing their determinants could help improve nutritional prevention interventions.For more than 11 000 children followed in the ELFE cohort (French Longitudinal Study since childhood), we calculated the age at introduction of complementary feeding (CFg) and of food groups, evaluated the uses of added sugar, salt and fat from 3 to 10 months old, and defined three principal components of early feeding. Their associations with familial characteristics were evaluated, taking in account the influence of the infant’s early growth of the child, by logistic or linear multivariate regressionsMost infants (62%) started CFg between 4 and 6 months old, 26% before 4 months old, and 12% from 6 months old onwards. Smoking, younger, born abroad and less educated mothers were more likely to introduce CFg before 4 months. Mothers who had a daughter, a second-born baby, had followed at least one birth preparation course and breastfed longer were more likely to introduce CFg after 6 months, unless the parents were born abroad.Vegetables, fruits and potatoes were the first groups introduced, mostly between 4 and 6 months. Before 10 months, 73% of children received infant cereals and only 32% of children received eggs. In contrast, 36% of children received fruit and more than 75% of children consumed sweet desserts. The introduction before 4 months of infant cereals, vegetables, fruits, potatoes and dairy products was associated with the same characteristics as CFg before 4 months. Being a girl and breastfeeding duration were positively related to the introduction of almost all food groups after 6 months.Three principal components were determined by 1/ a “higher” consumption frequency of the food groups, 2/ a foods consumption before 6 months, 3/ a longer breastfeeding duration and late introduction of infant formulas.About 30% of the children received added sugar and salt and 64% received added fat Breastfeeding was positively associated with the use of added fat, sugar and diet, while CFg before 4 months was positively related to the use of added sugar and salt and negatively to the use of added fatMaternal overweight and obesity were related to CFg before 4 months, with interactions between maternal BMI, child sex and maternal preoccupations related to child health.Children with higher weight and size and who gained weight the fastest at 3 months old were more likely to receive CFg earlier, especially before 4 months and less likely to receive added fat. Weight-for-age at 3 months was associated with a decrease in the use of added fat. A fear of overweight and lipidophobia could explain that fat is infrequently added.The planned longitudinal follow-up in ELFE will allow assessing the effect of these practices on the future growth of the children. Furthermore our results suggest the importance of taking into account familial characteristics, as well as feeding and infant caregiving practices and the sources of information used by families, to spread the recommendations by innovative and personalized channels.
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Marie Bournez. Déterminants des pratiques de diversification alimentaire des enfants de l’étude ELFE : données de santé, caractéristiques socio-économiques et démographiques familiales, croissance précoce de l’enfant.. Médecine humaine et pathologie. Université Bourgogne Franche-Comté, 2018. Français. ⟨NNT : 2018UBFCK060⟩. ⟨tel-02517038⟩

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