Introduction. In developing countries, children s weight gain commonly falters in relation to reference data

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1 nd feeding of complementry foods ffects mel-specific food consumption nd mel durtion y helthy, rest fed Bngldeshi children M. Munirul Islm 1, Thmeed Ahmed 1, Jnet M. Peerson 2, M. Aid Hossin Mollh 3, Mkhdum Khtun 1, Kthryn G. Dewey 2, Kenneth H. Brown 2 1 Interntionl Centre for Dirrhoel Disese Reserch, Bngldesh (icddr,), Dhk, Bngldesh 2 Progrm in Interntionl nd Community Nutrition, University of Cliforni, Dvis, CA, USA 3 Deprtment of Peditrics, Dhk Medicl College Hospitl, Dhk, Bngldesh Astrct Bckground: Approprite feeding of infnts nd young children is necessry to prevent growth fltering nd optimize helth during the first two yers of life. There is little informtion on the effects of dietry energy nd feeding of complementry foods on food consumption during individul mels nd the mount of cregiver time expended in child feeding. Methods: During nine seprte, rndomly ordered dietry periods lsting 3-6 dys ech, we mesured selfdetermined intkes of semi-solid cerel porridges y 18 helthy, restfed children 8-11 months of ge. The infnts were fed coded porridges with energy densities of.5, 1. or 1.5 kcl/g, during three, four, or five mels/dy. Complementry food intke ws mesured y weighing the feeding owl efore nd fter every mel. Results: Children consumed greter mounts of complementry foods per mel when they received diets with lower energy nd fewer mels per dy. Greter time ws expended per mel when fewer mels were offered. The time expended per mel did not vry with dietry energy, ut the children te more nd fster for the lower energy diets. Conclusions: We conclude tht the energy nd feeding of complementry foods ffect mel-specific food intke. Mel lso influences the durtion of individul mels, ut energy does not. These results provide further evidence of young children s ility to regulte their energy intkes, even during infncy, nd convey informtion on fctors tht ffect the mount of time tht cregivers must devote to child feeding. Cittion: Islm MM, Ahmed T, Peerson JM, Mollh MAH, Khtun M, Dewey KG, Brown KH (216) nd feeding of complementry foods ffects mel-specific food consumption nd mel durtion y helthy, rest fed Bngldeshi children. Adv Peditr Res 3:4. doi:1.715/pr Received: April 29, 215; Accepted: Septemer 19, 215; Pulished: Mrch 1, 216 Copyright: 216 Islm et l. This is n open ccess rticle distriuted under the terms of the Cretive Commons Attriution License, which permits unrestricted use, distriution, nd reproduction in ny medium, provided the originl work is properly cited. Competing interests: The uthors hve declred tht no competing interests exist. Sources of funding: This reserch project hs een funded y the Government of Bngldesh through the Improved Helth for the Poor: Helth, Nutrition nd Popultion Reserch Project. * Emil: mislm@icddr.org Introduction In developing countries, children s weight gin commonly flters in reltion to reference dt etween ~3 15 months of ge [1, 2], period when complementry foods re usully dded to their diets. The primry explntions for children s poor growth during this ge intervl include insufficient or Advnces in Peditric Reserch Islm et l :4 1

2 inpproprite dietry intkes nd frequent infections. Infnts older thn six months require complementry foods of pproprite energy nd nutrient densities in ddition to rest milk to meet their physiologicl requirements. The reltively high energy requirements of young children, together with their limited stomch cpcity, mke it difficult for them to stisfy their energy needs, prticulrly if the energy of the diet is low or if only few mels re offered ech dy [3, 4, 5]. Dietry energy nd feeding re independently relted to totl dily energy intke; thus, oth need to e considered in developing recommendtions for infnt feeding [5]. With the greter energy of complementry foods, fewer mels cn e provided nd, conversely, when more mels re offered, energy requirements cn e met with diets of lower energy. The effects of dietry energy nd feeding on food intkes from ech mel hve een studied in fully wened children recovering from mlnutrition [5]. The children consumed the gretest mount of food during the first mel of the dy, nd the mounts consumed during single mels were inversely relted to their energy nd the children s weight-for-length z-score [6, 7]. Interestingly, the children consumed greter mount of complementry food per minute when they received foods with lower energy. The sme reltionships etween feeding, dietry energy, nd totl dily energy intkes hve een oserved mong restfed children, ut no informtion hs een reported on mel-specific food consumption y helthy, restfed children. The mount n infnt ets during individul feeding episodes reflects not only the ppetite of the infnt, ut lso the composition of the mel nd the ttitudes nd ehviors of the cregiver [8, 9]. Stiety is lrgely determined y the mount of food tht is offered t ech mel [1, 11, ] nd the pltility of foods. Post-prndil stiety inhiits further eting following mel nd ffects the inter-mel intervl nd the mount consumed when food is next offered [13]. Infnts re le to modify their energy intkes when diets with vried energy re offered d liitum, even s erly s six weeks of ge [8]. Dietry studies tht collected mel-specific informtion on energy intke showed considerle mel-to-mel vriility [6, 14, 15, 16], wheres totl dily energy intke ws quite stle [15]. Cregivers time constrints due to other responsiilities cn influence their child s feeding ehviors [16, 17]. In poor households in lowerincome countries, women re generlly responsile for childcre; ut they hve multiple other household chores [17]. Thus, cregivers time vilility lso cn e n importnt determinnt of children s totl dietry intke. In this pper, we hve exmined under controlled conditions the effects of dietry energy nd feeding of complementry foods on the mount of food consumed nd time expended in feeding restfed children during ech mel. We hypothesized tht incresing the energy nd feeding of complementry foods would positively ffect energy intke from these foods, ut would necessitte greter mount of time for child feeding. Methods Study site nd prticipnts The reserch ws conducted in peri-urn community of Dhk, Bngldesh, nd the Advnced Bio Medicl Reserch Wrd (ABRU) of the Interntionl Centre for Dirrhoel Disese Reserch, Bngldesh (icddr,). Eighteen helthy children (8 oys nd 1 girls), ged 8 11 months, who reportedly were eing restfed t lest six times dy nd receiving complementry foods t lest twice dy were invited to prticipte in dietry screening studies in their homes. All children were required to hve length-for-ge z-score > -2. nd weight-for-length z- score etween -1.5 nd +1.5 with respect to interntionl reference dt [18], nd their mothers hd to hve ody mss index (BMI) >18.5 kg/m 2. Children were excluded if they hd ny cute or chronic illness or congenitl nomlies, or if they were exclusively restfed, exclusively formul fed, or fully wened. Written, informed consent ws otined from the mother of ech child. The reserch protocol ws pproved y the institutionl review ords of the University of Cliforni, Dvis nd icddr,. Advnces in Peditric Reserch Islm et l :4 2

3 Study protocol The cregivers reported feeding prctices were confirmed y direct oservtion during two consecutive -hour periods t their homes, s descried previously [19]. Eligile children nd their mothers were dmitted to the ABRU for period of 42 dys. During the initil three dy cclimtion period, the study children were provided with diet contining 1. kcl/g three times per dy. Thus, we were le to confirm tht ll the children would ccept the study diets nd tht their mothers were le to dhere to the study procedures. During the susequent study periods, complementry foods were offered three, four or five times per dy t prescheduled times. Specificlly, the mels were offered t 8 9, nd 2 21 hours when the feeding ws three mels per dy; 7 8, 11, nd 2 21 hours when the ws four mels per dy; nd 6 7, 93 13, , nd 2 21 hours when the ws five mels per dy. The mothers were dvised to restfeed ccording to their usul pre-study feeding pttern, or more frequently if the infnt demnded, except tht they were requested not to restfeed during the hour efore ech of the scheduled complementry feeds. Ech of the three study periods lsted for 13 dys. The sequence of the study periods ws rndomly ordered with regrd to the feeding, nd within ech permuttion of feeding the order of the energy densities ws lso rndomly llocted. An exmple of one dietry sequence is shown in Figure 1. Mesurement of complementry food intke All feeding episodes took plce under the supervision of clinicl stff. Food portions were weighed efore nd fter serving on n electronic lnce with.1 g precision (Srtorius TE 411, Goettingen, Germny), nd the ctul mount consumed ws clculted y sutrcting the mount of the leftover food from the mount offered. Pre-weighed npkins were provided to sw ny food tht ws vomited or spilled, nd ny such losses were sutrcted from the mount offered. Figure 1. Exmple of sequence of dietry regimen in study protocol. x indictes the dys on which mesurement ws mde; y indictes the dys for which dt on complementry food intke were included in the nlyses. For different sujects, the order of feeding ws rndomly ssigned y study period, nd the sequences of dietry energy were rndomly ssigned within ech level of feeding. Ech of the three study periods ws 13 dys. Advnces in Peditric Reserch Islm et l :4 3

4 During ech study period, the mothers were sked to spoon feed the respective diet to their child d liitum under the supervision of study personnel. Ech mel ws continued until the child refused the food on three occsions seprted y one minute rest period, s descried previously [19, 2]. The totl durtion of the feeding ws recorded excluding these rest periods. Sttisticl nlysis The primry response vriles were the mount of food consumed per mel (g/mel), energy intke from complementry foods (kcl/mel), nd totl time required for ech mel (min/mel). Dt were nlyzed from dys 5 nd 6 for the lowest energy diet (.5 kcl/g), nd dys 2 nd 3 for the two higher energy diets (1. kcl/g nd 1.5 kcl/g), s explined previously [19]. Descriptive sttistics (men, stndrd devition or stndrd error, s pproprite nd medin, inter-qurtile rnges) were clculted for ll continuous vriles. The dt were nlyzed with the SAS Mixed Model procedure, fter first confirming the norml distriution of the dependent vriles or completing ny necessry trnsformtions of dt. The min effects tht were included in the models were the mel numer (mel-1 through mel-5), dietry energy (three levels), of feeding (three levels), diet periods (three levels), individul (rndom) effects, nd the two-wy interctions etween energy nd mel numer, nd etween feeding nd mel numer. An utoregressive covrince structure ws ssumed for the within-individul error term. If, ny of the independent vriles ws found to e significnt (p <.5), then Tukey s test ws performed to exmine the pir-wise levels of significnce. Results Study prticipnts The infnts men length-for-ge nd weight-forlength z-scores were less thn the reference popultion medins [18], ut ll vlues were within the norml rnge, s per the study entry criteri. Mternl BMI rnged from 18.7 to 25.8 kg/m 2, so no mothers were considered to e chroniclly energy deficient or overweight. The men ges of the children nd mothers were ~9 months nd ~23 yers, respectively (Tle 1). Tle 1. Initil chrcteristics of the mothers nd children Chrcteristics Vlue Child s ge (months) 9.2 ±.9 (8, 11) Child s ody weight (kg) 7.46 ±.66 (6.36, 8.52) Child s length (cm) 66.9 ± 1.9 (64.2, 71.) Child s length-for-ge (z-score) ±.6 (-1.8 to.56) Child s weight-for-length (z-score) -.3 ±.6 (-1.37 to.84) Mother s ge (yers) 22.7 ± 2.5 (19., 28.) Mother s ody weight (kg) 44.5 ± 3.3 (4., 54.3) Mother s height (m) 1.48 ±.4 (1.39, 1.57) Mother s BMI (kg/m 2 ) 2.3 ± 1.6 (18.7, 25.8) All vlues re men ± SD; rnge in prentheses Sixty-six percent of mothers nd 77% of fthers hd 1 1 yers of school eduction. All the prticipnts houses hd electricity nd most hd ccess to drinking wter from nery stndpipes. The medin household income ws US$ 5. per month (Tle 2). Amount of complementry food intke The mounts of the children s food intke t individul mels (g/mel) re shown in Tle 3 in reltion to the energy nd feeding of the complementry food. The children consumed greter mount of complementry foods per mel when they were receiving diets with lower energy nd when fewer mels were offered per dy. In other words, when the feeding of complementry foods incresed, the mount of food consumption did not chnge proportiontely in ech mel. In prticulr, when fewer mels were offered, intkes per mel incresed throughout the dy. However, when more mels were provided, intkes tended to increse nd then decline during the course of the dy. Advnces in Peditric Reserch Islm et l :4 4

5 Tle 2. Socioeconomic chrcteristics of the study sujects Tle 3. Food intke (g/mel) y dietry energy, feeding nd mel numer Vrile Vlue (%) Mother s eductionl sttus No eduction 5 (28) 1 to 5 yers of school 6 (33) 6 to 1 yers of school 6 (33) More thn 1 yers of school 1 (6) Fther s eductionl sttus No eduction 4 (22) 1 to 5 yers of school 7 (39) 6 to 1 yers of school 7 (39) More thn 1 yers of school () Monthly fmily income (US$) 5 (41, 91) No. of rooms in the house 1 (1, 1.3) Roof mteril Concrete 1 (6) Corrugted tin 11 (61) Thtched 6 (33) Floor mteril Concrete 6 (33) Erthen 1 (56) Other 2 (11) Drinking wter Stndpipe 1 (56) Tue well 2 (11) Other 6 (33) Electricity Yes 18 (1) No () medin (inter-qurtile rnge) (kcl/g) (mels/dy) (kcl/g) (mels/dy) (kcl/g) (mels/ dy) Mel numer (45.) (44.4) (41.9) (34.9) (34.5) (45.5) (29.2) (46.) (55.1) (5.3) (47.8) (48.1) (49.6) (48.9) (55.2) (47.6) (52.6) (41.3) (55.9) (37.6) (34.8) (42.4) (45.6) (36.1) (49.6) (47.) (65.6) (46.2) (38.1) (41.6) (46.2) Similrly, there ws significnt interction etween dietry energy nd mel numer (p =.44). Intke per mel tended to increse throughout the dy with the lowest energy diet, ut increse nd fll with the two higher energy diets. The dt re presented in reltion to ody weights in Tle 4 nd Figures 2 nd 3, nd the sme mel-wise ptterns were evident s when solute mounts of food intke were considered. 5.9 (37.) 95.9 (42.2) 92.7 (45.1) 15.3 (38.2) 87.1 (38.6) All vlues re men (SD); Min effects y mixed model ANOVA: dietry energy, p <.1; feeding, p <.1; mel numer, p =.5; interction: dietry energy X mel numer, p =.44; interction: feeding X mel numer, p <.1 The mximum intke of complementry food from single mel for ny comintion of dietry energy nd feeding rnged from g/kg ody weight (men 25. ± 6.) for the different children. Advnces in Peditric Reserch Islm et l :4 5

6 Complementry food intke (g/kg BW/mel) Mel 3 mels/d 4 mels/d 5 mels/d Figure 2. Men (±stndrd error (SE) complementry food intke (g/kg BW/mel) y feeding of complementry foods, controlling for dietry energy. Food intkes per mel were significntly greter when fewer mels were offered (p <.1) nd there ws significnt interction etween feeding nd mel numer, (p =.), ANOVA. Within prticulr level of feeding, different letters re significntly different, p <.5, Tukey's test. BW is ody weight. Complementry food intke (g/kg BW/mel) Mel.5 kcl/g 1. kcl/g 1.5 kcl/g Figure 3. Men (±SE) complementry food intke (g/kg BW/mel) y dietry energy of complementry foods, controlling for feeding. Food intkes per mel were significntly greter with lower energy (p <.1), nd there ws significnt interction etween energy nd mel numer, (p =.46), ANOVA. Within dietry energy level, different letters re significntly different, p <.5, Tukey's test. BW is ody weight. Tle 4. Food intke (g/ody weight -1 per mel) y dietry energy, feeding nd mel numer (kcl/g) (mels/dy) (kcl/g) (mels/dy) (kcl/g) (mels/dy) Mel numer (7.) (4.4) (6.) (5.8) (5.4) (4.6) (5.8) 4.9 (5.1) 5.4 (4.2) 17.3 (5.1) 15.7 (4.3) 14. (6.9) 16.1 (5.8) 16.7 (6.2).5 (4.2) 14.5 (5.4) 13. (4.1) 11.6 (5.1) 16.8 (4.9) 16. (5.6) 15.6 (6.4) 17. (6.3) 16. (5.) 15. (5.3) 16. (7.8) 13.7 (5.2) 11.2 (5.5) 16.7 (3.9) 16.2 (6.) 14.8 (6.5) 13.8 (5.4).5 (5.6).8 (4.6) 16. (6.2) 13.3 (4.6) 1.6 (4.7) All vlues re men (SD); Min effects y mixed model ANOVA: dietry energy, p <.1; feeding, p <.1; mel numer, p =.3; interction: dietry energy X mel numer, p =.46; interction: feeding X mel numer, p =. Advnces in Peditric Reserch Islm et l :4 6

7 The mximum mount consumed occurred with the lowest nd lowest dietry regimen. increse during the course of the dy with the lower energy diet. intke from complementry food Figure 4 illustrtes the energy intke per kg t individul mels (kcl/kg ody weight -1 mel -1 ) in reltion to feeding while controlling for dietry energy. intke per mel ws greter when three mels were offered, nd the intke incresed during the course of the dy. By contrst, there were no significnt mel-relted chnges during the dy when more mels were served. intke from complementry food (kcl/kg BW/mel) Mel 3 mels/d 4 mels/d 5 mels/d Figure 4. Men (±SE) energy intke from complementry food (kcl/kg BW/mel) y feeding of complementry foods, controlling for dietry energy. intke per mel ws significntly greter when fewer mels were offered (p <.1), nd there ws significnt interction etween feeding nd mel numer, (p =.19), ANOVA. Within prticulr level of feeding, different letters re significntly different, p <.5, Tukey's test. BW is ody weight. The mel-specific energy intkes (kcl/kg ody weight -1 mel -1 ) re shown in Figure 5 in reltion to dietry energy controlling for feeding. intkes per mel were significntly greter with higher energy diets, nd energy intkes did not vry y mel numer. On the other hnd, the energy intkes t ech mel tended to intke from complementry food (kcl/kg BW/mel) Mel.5 kcl/g 1. kcl/g 1.5 kcl/g Figure 5. Men (±SE) energy intke from complementry food (kcl/kg BW/mel) y dietry energy of complementry foods, controlling for feeding. intke per mel ws significntly greter with higher energy diets (p <.1) nd there ws no significnt interction etween energy nd mel numer, (p =.15), ANOVA. BW is ody weight. Time expended for food consumption The time expended during individul mels (min/mel) is shown in reltion to the energy nd feeding of complementry food in Tle 5. The men mounts of time expended for ech mel rnged from 7.6 to 1.4 minutes in reltion to different comintions of dietry energy nd feeding. Significntly more time ws expended to complete individul mels when fewer mels were provided per dy (p <.1) (Figure 6), nd there ws significnt interction etween feeding nd mel numer (p =.2). The time expended per mel did not vry significntly throughout the dy when three or four mels were offered; however, the time spent feeding ech mel decresed during the dy when more mels were provided. Advnces in Peditric Reserch Islm et l :4 7

8 time (min/mel) c c c when four or five mels were provided. Food intke ws significntly fster with the low diet compred with the high diets (Figure 9), nd the intke velocity tended to increse during the dy with the low diets, ut not the higher one. There ws significnt positive reltion etween the time expended during ech mel nd the mount of complementry food consumed per minute (p <.1). Regrdless of the energy nd feeding of complementry foods, for ech dditionl minute of durtion of ech mel, the velocity of food intke (g/min) ws 2.7 g greter per mel. Mel 3 mels/d 4 mels/d 5 mels/d Figure 6. Men (±SE) complementry feeding time (min/mel) y feeding of complementry foods, controlling for dietry energy. The time expended per mel ws significntly greter when fewer mels were offered per dy (p <.1) nd there ws significnt interction etween feeding nd mel numer, (p =.2), ANOVA. Within prticulr level of feeding, different letters re significntly different, p <.5, Tukey's test. There were no significnt effects of dietry energy on time expended per mel (p =.77) nd no significnt interctions etween energy nd mel numer (Figure 7) (p =.144). In generl, there ws slight, ut non-significnt, decline in time per mel during the course of the dy, regrdless of the dietry energy. Food intke velocity Figure 8 illustrtes the velocity of food consumption (g/kg ody weight -1 min -1 ) t ech mel in reltion to feeding, controlling for dietry energy. There were no overll differences in feeding velocity y feeding, ut there ws significnt interction etween feeding nd mel numer (p =.5). When three mels per dy were offered there were no mel-wise differences in velocity of food intke, ut the velocity of intke incresed nd declined during the course of the dy time (min/mel) Mel.5 kcl/g 1. kcl/g 1.5 kcl/g Figure 7. Men (±SE) complementry feeding time (min/mel) y dietry energy of complementry foods, controlling for feeding. There ws no significnt effect of energy on time expended per mel (p =.77) nd there ws no significnt interction etween energy nd mel numer, (p =.144), ANOVA. For ll dietry energy levels comined, there ws significnt effect of mel numer (p =.2) nd different letters re significntly different, p <.5, Tukey's test. Discussion The results of this study indicte tht the mounts consumed nd energy intkes from complementry foods y helthy, restfed infnts 8 11 months ge, Advnces in Peditric Reserch Islm et l :4 8

9 nd the time expended during individul mels of the dy re ffected y the feeding nd energy of these foods. Velocity of food intke (g/kg BW/min) Mel 3 mels/d 4 mels/d 5 mels/d Figure 8. Men (±SE) velocity of complementry food intke (g/kg BW/min/mel) y feeding of complementry foods, controlling for dietry energy. The velocity of food intke t ech mel ws significntly greter when more mels were offered per dy (p <.1), nd there ws significnt interction etween feeding nd mel numer, (p =.5), ANOVA. Within prticulr level of feeding, different letters re significntly different, p <.5, Tukey's test. BW is ody weight. Children tend to consume more during individul mels when they receive lower energy diets nd fewer mels per dy. These results re consistent with previously pulished studies conducted in nonrestfed, recovering mlnourished children [5, 6]. Interestingly, children in the current study tended to consume less food during the first mel of the dy thn the rest of the mels, which ws not the cse in previous study [6]. However, the children in the current study were ll restfeeding d liitum dy nd night. Thus, it is likely tht they were prtilly sted y night-time nd erly morning restfeeding efore the first mel of the dy ws served. The children grdully incresed their food intke during the first three to four mels of the dy nd then either decresed or stilized their intkes during the following mel(s), depending on the different comintions of feeding nd energy. It seems tht during periods of higher feeding or energy the children were more sted erlier in the dy, nd their intkes declined during the lter mels. The functionl gstric cpcity of the young children hs een defined in previous studies s the mount they consume when energy nd/or feeding is so low tht they re unlikely to e meeting their energy needs, nd thus consuming mximlly. Velocity of food intke (g/kg BW/min) Mel.5 kcl/g 1. kcl/g 1.5 kcl/g Figure 9. Men (±SE) complementry food intke (g/kg BW/min/mel) y dietry energy of complementry foods, controlling for feeding. The velocity of food intke ws significntly greter with lower energy diets (p <.1), nd there ws significnt interction etween energy nd mel numer, (p =.19), ANOVA. Within prticulr level of dietry energy, different letters re significntly different, p <.5, Tukey's test. BW is ody weight. In previous studies of non-restfed children the functionl gstric cpcity vried from 4 to 66 g/kg ody weight from single mel when they were receiving diet contining.5 kcl/g five times per dy [6]. Advnces in Peditric Reserch Islm et l :4 9

10 Tle 5. Time expended during individul mels (min/mel), y dietry energy, feeding nd mel numer (kcl/g) (mels/dy) (kcl/g) (mels/dy) (kcl/g) (mels/dy) Mel numer (2.7) (3.1) (3.9) (4.8) (3.) (3.9) (3.2) (3.1) 9.7 (2.6) 9.4 (3.4) 9.2 (3.1) 1.1 (2.9) (2.6) 1.1 (2.9) (3.5) 1. (2.9) 8.9 (2.7) 7.4 (2.) 1.4 (3.9) (3.9) 9.9 (3.2) 7.6 (2.5) 8.5 (2.7) 8.3 (2.6) 9.4 (3.5) 8.4 (2.9) 9.5 (3.4) (2.5) 7.9 (3.) 7.9 (2.7) All vlues re men (SD); Min effects y mixed model ANOVA: dietry energy, p =.78; feeding, p <.1; mel numer, p =.2; interction: dietry energy X mel numer, p =.144 The mximum single-mel intkes of the children in the present study were considerly less thn the previously pulished informtion [6, 17, 21], ut those studies were conducted in non-restfed, recovering mlnourished children, whose energy intkes from food (nd, presumly, the totl energy needs) were considerly greter thn those of the children in the present study. Thus it is likely tht the children in the present study were not eting to their full gstric cpcity. Accordingly, the current informtion on mel-specific mounts of food consumption re proly more relistic estimtes of the likely levels of intke y non-mlnourished children who re eing restfed d liitum. The men feeding times rnged from 7.6 to 1.4 minutes per mel in reltion to different comintions of feeding nd dietry energy, which ws out hlf the mel durtions oserved during previous studies [5, 7, 2]. In two of the three previous studies [5, 7], the children were mlnourished, so they my hve needed more time to stisfy their higher energy requirements. In the present study, the mount of time required for feeding individul mels vried ccording to the feeding, ut not in reltion to dietry energy. However, the children consumed greter mount of food per minute when they were fed the lower energy diets, indicting tht they were eting fster under these conditions. These results re consistent with previous oservtions in nonrestfed children. The children in the current study lso te fster when more mels were provided per dy, finding tht differs from previous study [5]. The reson for the ltter difference etween studies is uncertin, lthough the children of the current study were slightly younger thn those in previous studies (men ge ~9 months vs 14 months) nd the current children were fed y their mothers, rther thn y professionl nursing ides. It is possile tht the mothers were more responsive to their childrens feeding cues. These results provide further evidence of children s self-regultion of food energy intke, even efore one yer of ge. Notly, this regultion occurs t the level of individul mels nd is chieved y modifying oth the durtion of the mel nd the velocity of consumption. Not only do these results provide insight into the regultion of food intkes y young children, ut they hve implictions with regrd to child feeding prctices nd cregivers time requirements for child feeding. Interestingly, there ppers to e reltively little vriility in totl mel durtion efore stiety is chieved. Thus, it is criticl for the cregivers to e ttentive to cues tht the child is willing to et nd offer sufficient food s it is solicited. In situtions where limited cregiver time is ville for child feeding, the totl mount of time devoted ech dy cn e reduced y lowering the feeding. However, the lower feeding Advnces in Peditric Reserch Islm et l :4 1

11 must e compensted for y greter energy to ensure tht dequte energy intke cn e chieved, s descried elsewhere [19]. Conclusions Helthy, restfed children consume greter mount of food when the food hs lower energy nd fewer mels re offered, ut they et fster under these conditions, therey prcticlly regulting their dily energy intkes. Moreover, the mel-specific pttern of consumption vries ccording to the feeding regimen, with intkes incresing progressively when fewer mels nd lower energy diets re offered, ut incresing nd then declining when higher diets nd more mels re provided. References 1. Victor CG, de Onis M, Hlll PC, Blössner M, Shrimpton R. Worldwide timing of growth fltering: revisiting implictions for interventions. Peditrics. 21;5(3):e Shrimpton R, Victor CG, de Onis M, Lim RC, Blössner M, Clugston G. Worldwide timing of growth fltering: implictions for nutritionl interventions. Peditrics. 21;17(5):E Svnerg, U. Dietry ulk in wening foods nd its effect on food nd energy intke. In: Improving young child feeding in Estern nd Southern Afric. Household-level food technology. Proceedings of workshop held in Niroi, Keny. -16 Octoer, Ottw, Cnd: Interntionl Development Reserch Centre, pp ; Kingmkono, R.P.Effect of food consistency on nutrient intke in young children. In: Improving young child feeding in Estern nd Southern Afric. Householdlevel food technology. Proceedings of workshop held in Niroi, Keny. -16 Octoer, Ottw, Cnd: Interntionl Development Reserch Centre, pp ; Brown KH, Snchez-Griñn M, Perez F, Peerson JM, Gnoz L, Stern JS. Effects of dietry energy nd feeding on totl dily energy intkes of recovering mlnourished children. Am J Clin Nutr. 1995;62(1): Snchez-Griñn MI, Peerson JM, Brown KH. Effect of dietry energy on totl d-liitum energy consumption y recovering mlnourished children. Eur J Clin Nutr. 1992;46(3): Bennett VA, Morles E, González, J, Peerson JM, Lόpez de Romñ G, Brown KH. Effects of dietry viscosity nd energy on totl energy consumption y young Peruvin children. Am J Clin Nutr.1999;7: Fomon SJ. Infnt nutrition. 2 nd ed. Phildelphi: WB Sunders Co.; Drucker RR, Hmmer LD, Agrs WS, Bryson S. Cn mothers influence their child's eting ehvior? J Dev Behv Peditr. 1999;2(2): Druce M, Bloom SR. The regultion of ppetite. Arch Dis Child. 26;91(2): Rolls B, Brnett RA. The volumetrics weight-control pln: feel full on fewer clories. New York: Hrper Collins; 2.. Drewnowski A. Pltility nd stiety: models nd mesures. Annles Nestle. 1998;56: Rolls BJ. Sensory-specific stiety. Nutr Rev. 1986;44(3): Blck AE, Cole TJ, Wiles SJ, White F. Dily vrition in food intke of infnts from 2 to 18 months. Hum Nutr Appl Nutr. 1983;37(6): Birch LL, Johnson SL, Andresen G, Peters JC, Schulte MC. The vriility of young children's energy intke. N Engl J Med. 1991;324(4): Percey SM, de Cstro JM. Food intke nd mel ptterns of one yer old infnts. Appetite. 1997;29(2): Brown KH, Dewey KG, Allen LH. Complementry of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Genev, Switzerlnd. World Helth Orgniztion, (WHO/NUT/98.1), United Sttes, Ntionl Center for Helth Sttistics (US NCHS). NCHS growth curves from children irth -18 Yers. Vitl Helth Sttistics, 1977;11, 165. (DHEW puliction no. PHS ). 19. Islm MM, Khtun M, Peerson JM, Ahmed T, Mollh MA, Dewey KG, Brown KH. Effects of energy nd feeding of complementry foods on totl dily energy intkes nd consumption of rest milk y helthy restfed Bngldeshi children. Am J Clin Nutr.28;88(1): Islm MM, Peerson JM, Ahmed T, Dewey KG, Brown KH. Effects of vried energy of complementry foods on rest-milk intkes nd totl energy consumption y helthy, restfed Bngldeshi children. Am J Clin Nutr. 26;83(4): Dewey KG, Brown KH. Updte on technicl issues concerning complementry feeding of young children in developing countries nd implictions for intervention progrms. Food Nutr Bull. 23;24(1):5-28. Advnces in Peditric Reserch Islm et l :4 11