Infant feeding practices among Norwegian-Somali and Norwegian-Iraqi infants
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AbstractAdequate nutrition during the first year of life is essential for optimal growth and health. Previous studies from various countries have shown disparities in infant feeding practices among subgroups in a population. In Norway, national dietary surveys have indicated that the majority of Norwegian infants are fed in accordance with infant feeding recommendations. These surveys have, however, not included infants of foreign-born mothers, and the Norwegian Directorate of Health has called for separate studies on this group of children. The InnBaKost study was initiated in 2012 to reduce the knowledge gap. The work presented in this thesis is a part of this study, and the present work aimed to generate knowledge about infant feeding practices among Norwegian-Somali and Norwegian-Iraqi infants at 6 and 12 months of age. In addition, the work presented focused on developing suitable methods in order to obtain these data. Two cross-sectional surveys were performed in eastern Norway, when the infants were 6 and 12 months of age. The convenience sampling method was used to recruit eligible mothers. A semi-quantitative food frequency questionnaire (FFQ) adapted from the national dietary survey was used at 6 months. The FFQ was designed to estimate breastfeeding and complementary feeding practices at 6 months of age and, retrospectively, from birth up to the given age. A repeated 24-hour multiple-pass recall method was developed and tested, and thereafter used to describe food and nutrient intake among 12-month-old Norwegian-Somali and Norwegian-Iraqi infants. Nutrient intake from the two recalls was compared to the recommended daily ranges and intakes of macro- and micronutrients. Parental and child background characteristics were provided in all surveys. In the 6-month survey, 107 mothers/infants of Somali origin and 80 mothers/infants of Iraqi origin participated. Breastfeeding was almost universally initiated, but only 7% of the Norwegian-Somali and 10% of the Norwegian-Iraqi infants were exclusively breastfed at 4 months of age. More than half of the infants were introduced to infant formula and water during the first three months of life. Solid and/or semi-solid foods had been introduced to 54% of the Norwegian-Somali infants and 68% of the Norwegian-Iraqi infants at 4 months of age. A higher proportion of Norwegian-Somali infants (79%) were breastfed at 6 months of age compared to Norwegian-Iraqi infants (58%). None of the background characteristics analysed were significantly associated with exclusive breastfeeding at 3.5 months of age, while maternal country of origin (Somalia) and parity (>2 children) was positively associated with breastfeeding at 6 months of age. Prior to the 12-month survey, a pilot survey was performed on 12 mothers of Somali and Iraqi origin to develop and test tools for the 24-hour multiple-pass recall method that was to be used in the 12-month survey. The method was described as feasible and the visual tools useful by participating mothers and field workers, although some improvements were recommended. In the 12-month survey, 89 mothers/infants of Somali origin and 77 mothers/infants of Iraqi origin participated. At this age, 40% of Norwegian-Somali and 47% of Norwegian-Iraqi infants were still breastfed. Median energy percentages (E%) from macronutrients were within the recommended daily intake ranges, except the level of saturated fats, which was 12- 13 E%. Median intakes of almost all micronutrients were above the recommended daily intake. The majority of infants received iron-enriched products and vitamin D supplements. Infants not receiving iron-enriched products had a low median intake of iron compared to infants receiving such products (3.7 mg/day vs. 8.1 mg/day, respectively). Infants not receiving vitamin D supplements had a low median intake of vitamin D compared to infants receiving such supplements (4.1 µg/day vs. 14.5 µg/day). In conclusion, breastfeeding initiation was common, but the duration of exclusive breastfeeding was short among both infants of Somali and Iraqi origin, and much shorter than what was found among native Norwegian infants in the national dietary surveys. The proportion of Norwegian-Somali and Norwegian-Iraqi infants still breastfed at 12 months of age was similar to the proportion found in the national dietary surveys. Large proportions of the Norwegian-Somali and Norwegian-Iraqi infants were fed in accordance with the Norwegian infant feeding recommendations at 12 months of age, however, potential for improvement exists. From a public health perspective, this thesis underlines that culturespecific approaches should be promoted to support infant feeding practices among foreignborn mothers in Norway. Research to better understand social inequalities and research to explore infant feeding practices among other immigrant populations in the society are needed. Validity studies should also be performed to provide validity evidence of the methods used.
List of papers
|Paper I Grewal NK, Andersen LF, Sellen D, Mosdol A, Torheim LE. Breast-feeding and complementary feeding practices in the first 6 months of life among Norwegian-Somali and Norwegian-Iraqi infants: the InnBaKost survey. Public Health Nutrition. 2015 Jun 24:1-13. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1017/S1368980015001962|
|Paper II Grewal NK, Mosdol A, Aunan MB, Monsen C, Torheim LE. Development and pilot testing of 24-hour multiple-pass recall to assess dietary intake of toddlers of Somali- and Iraqi-born mothers living in Norway. Nutrients. 2014 Jun;6(6):2333-47. Published with a Creative Commons Attribution 3.0 Unported License. https://doi.org/10.3390/nu6062333|
|Paper III Grewal NK, Andersen LF, Kolve CS, Kverndalen I, Torheim LE. Food and nutrient intake among 12-month-old Norwegian-Somali and Norwegian-Iraqi infants. Submitted. To be published. The paper is removed from the thesis in DUO awaiting publishing.|