Early consumption of liquids different to breast milk in Mexican infants under 1 year : results of the probabilistic National Health and Nutrition Survey 2012

Introduction: Studies on infant dietary intake do not generally focus on the types of liquids consumed. Objective: To document by age and breastfeeding status, the types of liquids present in the diet of Mexican children under 1 year of age (< 1 y) who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Methods: Analysis of the infant < 1 y feeding practices from the ENSANUT-2012 survey in non-breastfed (non-BF) and breastfed (BF) infants by status quo for the consumption of liquids grouped in: water, formula, fortified LICONSA milk, nutritive liquids (NL; thin cereal-based gruel with water or milk and coffee with milk) and non-nutritive liquids (non-NL) as sugared water, water-based drinks, tea, beans or chicken broth, aguamiel and coffee. In this infants < 1 y we analyzed the not grouped consumption of liquids in the first three days of life (newborns) from the mother’s recall. Percentage and confidence intervals (95% CI) were calculated adjusting for survey design. Statistical differences were analyzed by Z test. Results: We observed a high consumption of human milk followed by formula (56.7%) and water (51.1%) in infants under 6 months of age (< 6 mo). The proportion of non-BF infants consuming non-NL was higher than for BF infants (p < 0.05). More than 60% of older infants (6 mo and < 1 y) consumed formula and were non-BF. In newborns formula consumption was predominant, followed by tea or infusion and water. Conclusions: Non-breast milk liquids are present undesirably in Mexican infants’ diet and non-NL are consumed earlier than NL, revealing inadequate early dietary practices. 15 EARLY CONSUMPTION OF LIQUIDS DIFFERENT TO BREAST MILK IN MEXICAN INFANTS UNDER 1 YEAR: RESULTS OF THE PROBABILISTIC NATIONAL HEALTH AND NUTRITION SURVEY 2012 [Nutr Hosp 2016;33(1):14-20] INTRODUCTION Mexico is experiencing nutritional changes in terms of consumption of foods and liquids (1). Early introduction of liquids other than breast milk, nutritive or not, has been documented in Mexican infants < 2 years of age (2). Recently, Özen et al. (3) conducted a systematic review on the consumption of fluid intake from representative populations of all age groups in more than 20 countries. Out of more than 1,200 studies reviewed, 65 were included in their analysis and only two of them collected information for infants < 1 y. These two studies revealed a high level of consumption of what could be called non-nutritive liquids such as tea, coffee, fruit or vegetable juice or soft drinks, as well as consumption of nutritive liquids including whole, skimmed or flavored milk. The World Health Organization (4) recommends exclusive breastfeeding for the first 6 months of life and continued breastfeeding for 24 months or more if mother and child so desire, accompanied by an adequate introduction of nutritive semisolids and solids foods from 6 months (5,6). There is no evidence of a benefit to the BF infants by introducing water or glucose water before 6 months. Conversely, there is an increased risk of early cessation of breast feeding (7). In developing countries, early introduction of complementary foods is of public health concern because of the risk of a greater incidence of infections and diarrheal disease due to potential contamination (8,9), as well as to their potential to displace breast milk consumption. The guiding principle for complementary feeding as far as liquids are concerned is to emphasize avoidance of sugar-sweetened beverages (SSBs), tea, coffee and other non-nutritive liquids, due to the adverse effects on the infant’s health or appetite (4). Early introduction of complementary foods and displacement of breast milk are associated with overall dietary nutrient inadequacy and suboptimal childhood growth, underweight, and developmental delay (8-10). Furthermore, a higher body mass index (BMI) has been observed in preschool age children who were formula fed compared to exclusively breastfed (11). A poor diet based in non-nutritive liquids is a common cause of iron and zinc deficiency in this age group (12,13). When infants consume non-nutritive liquids they are exposed to sweet (or savory) foods or formulas during early life which predisposes them to preferences for similarly flavored foods later in life (14,15). There is evidence that Mexican preschool and school-aged children have increased their consumption of milk (and milk products) (16) and SSBs (17). Consumption of other non-nutritive liquids such as coffee and broths (chicken of bean), sweetened water or teas by Mexican infants is very common (18). However, nationally representative data on liquid consumption by the general population or for specific age groups is scarce. The objective of the study is to document, by age and breastfeeding status, the types of liquids consumed by Mexican infants < 1 year of age who participated in the National Health and Nutrition Survey (ENSANUT-2012 by its Spanish acronym). METHODS