Journal of Human Nutrition and DieteticsVolume 37, Issue 2 p. 393-395 EDITORIAL A changing of the guard: reflecting on the past and looking to the future at JHND Lauren Ball, Corresponding Author Lauren Ball [email protected] Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, Queensland, Australia Correspondence Lauren Ball, Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, Queensland 4072, Australia. Email: [email protected]Search for more papers by this authorSimon Langley-Evans, Simon Langley-Evans School of Biosciences, University of Nottingham, Loughborough, Simon, UKSearch for more papers by this author Lauren Ball, Corresponding Author Lauren Ball [email protected] Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, Queensland, Australia Correspondence Lauren Ball, Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, Queensland 4072, Australia. Email: [email protected]Search for more papers by this authorSimon Langley-Evans, Simon Langley-Evans School of Biosciences, University of Nottingham, Loughborough, Simon, UKSearch for more papers by this author First published: 16 January 2024 https://doi.org/10.1111/jhn.13272Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT The authors declare no conflicts of interest. REFERENCES 1Langley-Evans SC. Journal impact factor: a redundant metric for a bygone era. J Hum Nutr Diet. 2023; 36: 5–11. 10.1111/jhn.13102 PubMedWeb of Science®Google Scholar 2Langley-Evans SC. Reflections on a decade as Editor. J Hum Nutr Diet. 2022; 35: 1009–1011. 10.1111/jhn.13097 PubMedWeb of Science®Google Scholar 3Langley-Evans SC. Bad science: time for our community to do better. J Hum Nutr Diet. 2023; 36: 1127–1130. 10.1111/jhn.13165 PubMedWeb of Science®Google Scholar 4Crouse J, Feuling M, Winter T, et al. Electronic health record time-tracking provides real-time data to measure and benchmark dietitian productivity. J Hum Nutr Diet. Epub 2023 Sep 18. https://doi.org/10.1111/jhn 10.1111/jhn Web of Science®Google Scholar 5Fleming C, Sharma D, Brunacci K. Fix my food: an urgent call to action from adolescents on how they experience and want to see change in their food systems. J Hum Nutr Diet. 2023 Dec; 36(6): 2295–2309. Epub 2023 Sep 20. https://doi.org/10.1111/jhn.13228 10.1111/jhn.13228 PubMedWeb of Science®Google Scholar 6Carlsson L, Poulia K, Madden A. Sustainability in dietetics means embracing complexity, contributing and collaborating. J Hum Nutr Diet. 2023 Dec; 36(6): 2123–2126. Epub 2023 Oct 21. https://doi.org/10.1111/jhn.13257 10.1111/jhn.13257 PubMedWeb of Science®Google Scholar 7Wedlake L, Mellor D, Marriott T, et al. What do readers want? Results of an online survey to involve readers in updating the seventh edition of the Manual of dietetic practice. J Hum Nutr Diet. Epub 2023 Oct 15. https://doi.org/10.1111/jhn.13254 10.1111/jhn.13254 Web of Science®Google Scholar 8Campbell K, Cammer A, Moisey L, et al. Critically appraising and utilising qualitative health research evidence in nutrition practice. J Hum Nutr Diet. Epub 2023 Nov 14. https://doi.org/10.1111/jhn.13259 10.1111/jhn.13259 Web of Science®Google Scholar 9Damigou E, Detonoulou P. Antonopoulou, et al. Food Compass Score predicts incident cardiovascular disease: The ATTICA cohort study (2002-2022). J Hum Nutr Diet. Epub 2023 Oct 31. https://doi.org/10.1111/jhn.13247 10.1111/jhn.13247 Google Scholar 10Neff R, Ramsing R, Kim B. Commercial weight-loss diets, greenhose gas emissions and freshwater consumption. J Hum Nutr Diet. 2023 Dec; 36(6): 2268–2279. Epub 2023 Oct 22. https://doi.org/10.1111/jhn.13248 10.1111/jhn.13248 PubMedWeb of Science®Google Scholar 11Whatnall M, Clarke E, Bucher T, et al. Happy Little Vegemites™! An analysis of the contribution of yeast extract spreads and tomato-based sauces to nutrient intake adequacy in Australia. J Hum Nutr Diet. Epub 2023 Oct 18. https://doi.org/10.1111/jhn.13255 10.1111/jhn.13255 Google Scholar 12Gichohi-Wainaina W, Kee-Tui S, Zoethout M, et al. Determinants of dietary diversity and drivers of food choice among low-income consumers in urban Kenya, Malawi and Zimbabwe. J Hum Nutr Diet. 2023 Dec; 36(6): 2180–2200. Epub 2023 Oct 5. https://doi.org/10.1111/jhn.13244 10.1111/jhn.13244 PubMedWeb of Science®Google Scholar 13Graybeal AJ, Brandner CF, Tinsley GM. Validity and reliability of a mobile digital imaging analysis trained by a four-compartment model. J Hum Nutr Diet. 2023; 36(3): 905–911. 10.1111/jhn.13113 PubMedWeb of Science®Google Scholar 14Silva VC, Gorgulho B, Marchioni DM, Araujo TA, Santos IS, Lotufo PA, et al. Clustering analysis and machine learning algorithms in the prediction of dietary patterns: cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Hum Nutr Diet. 2022; 35: 883–894. 10.1111/jhn.12992 PubMedWeb of Science®Google Scholar Volume37, Issue2April 2024Pages 393-395 ReferencesRelatedInformation

Qualitative research methods are increasingly used in nutrition and dietetics research. Ethnography is an underexploited approach which seeks to explore the diversity of people and cultures in a given setting, providing a better understanding of the influences that determine their choices and behaviours. It is argued that traditional ethnography, that is, the methodology of living within participant communities, is a dated practice, with roots in colonialism, accessible to only researchers with the means, connections and status to conduct such research, typically white, privileged males. This paper proposes a formal interpretation of 'patchwork ethnography', whereby research is carried out in situ around existing modern-day commitments of the researcher, thus enabling more researchers within health, nutrition and dietetic practice to benefit from the rich data that can be discovered from communities. This review proposes the concept that pragmatic patchwork ethnography is required, proposing a framework for implementation, providing researchers, particularly within the fields of human nutrition, dietetics and health, the accessibility and means to deploy a meaningful client-centric methodology. We present pragmatic patchwork ethnography as a modern method for use within multiple healthcare settings, thus adding a progressive brick in the wall of qualitative research. This review proposes 'pragmatic patchwork ethnography', a qualitative methodology whereby research is carried out in situ around existing commitments of health researchers. It is a practical, implementable solution that allows researchers in the fields of human nutrition, dietetics and health to collect client-centric rich data effectively and efficiently.image Ethnography in health research allows professionals to gather rich qualitative data such as lived experiences of participants.However, undertaking traditional ethnography can be demanding, costly and time-consuming, consequently rendering it inaccessible and challenging to undertake.Pragmatic patchwork ethnography is underpinned by guiding principles of traditional ethnography, enabling researchers to weave the method into existing life and health practice commitments.This paper sets out the seven steps required to deploy pragmatic patchwork ethnography enabling and empowering public health, nutrition and dietetic researchers to undertake valuable qualitative research in a contemporary research landscape.

There is no conflict of interest to declare.

The author declare no conflict of interests.

Journal of Human Nutrition and DieteticsEarly View EDITORIAL Burnout: The peril stalking academics and researchers Simon C. Langley-Evans, Corresponding Author Simon C. Langley-Evans [email protected] University of Nottingham, School of Biosciences, Sutton Bonington, Loughborough, UK Correspondence Simon C. Langley-Evans, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough LE12 5RD, UK. Email: [email protected]Search for more papers by this author Simon C. Langley-Evans, Corresponding Author Simon C. Langley-Evans [email protected] University of Nottingham, School of Biosciences, Sutton Bonington, Loughborough, UK Correspondence Simon C. Langley-Evans, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough LE12 5RD, UK. Email: [email protected]Search for more papers by this author First published: 17 April 2023 https://doi.org/10.1111/jhn.13135Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

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Human milk is influenced by maternal habitual diet, yet we do not fully understand the short-term effects of dietary variations on breast milk macronutrient concentrations. This study aimed to determine if increasing sugar and fat consumption would impact breast milk protein, lactose and lipids. Nine mothers who were exclusively breast-feeding consumed three diets; a control, a higher fat diet and a higher sugar diet at least 1 week apart. Breast milk samples were collected hourly and analysed for concentrations of protein, lactose, triglycerides and cholesterol. Breast milk triglycerides responded to both intervention diets with significantly higher concentrations in comparison to the control diet (p < 0.001). Cholesterol concentrations increased more in response to the higher sugar diet than the higher fat diet (p < 0.005). Lactose concentrations increased in response to the higher fat diet (p = 0.006), and protein decreased in response to the higher fat diet (p = 0.05). Variations in breast milk composition were observed over the day with triglyceride and cholesterol concentrations highest at the end of day (p < 0.001), and lactose and protein concentrations peaking at hour 10 (p < 0.001). Manipulating maternal consumption of fat and sugar impacted concentrations of human milk triglycerides, cholesterol, lactose and protein. Fluctuations were also seen in milk macronutrients in response to time of day.

Journal of Human Nutrition and DieteticsVolume 36, Issue 3 p. 585-587 EDITORIAL Novel approaches for assessing dietary intake and behaviours Simon C. Langley-Evans, Corresponding Author Simon C. Langley-Evans [email protected] School of Biosciences, University of Nottingham, Loughborough, UK Correspondence Simon C. Langley-Evans, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK. Email: [email protected]Search for more papers by this author Simon C. Langley-Evans, Corresponding Author Simon C. Langley-Evans [email protected] School of Biosciences, University of Nottingham, Loughborough, UK Correspondence Simon C. Langley-Evans, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK. Email: [email protected]Search for more papers by this author First published: 17 April 2023 https://doi.org/10.1111/jhn.13146Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Kelly JT, Collins PF, McCamley J, Ball L, Roberts S, Campbell KL. Digital disruption of dietetics: are we ready? J Hum Nutr Diet. 2021; 34: 134–46. 10.1111/jhn.12827 CASPubMedWeb of Science®Google Scholar 2Green SM, James EP, Latter S, Sutcliffe M, Fader MJ. Barriers and facilitators to screening for malnutrition by community nurses: a qualitative study. J Hum Nutr Diet. 2014; 27: 88–95. 10.1111/jhn.12104 CASPubMedWeb of Science®Google Scholar 3Langley-Evans SC. Nutrition screening tools: still no consensus 40 years on. J Hum Nutr Diet. 2021; 34: 923–925. 10.1111/jhn.12952 PubMedWeb of Science®Google Scholar 4McCray S, Barsha L, Maunder K. Implementation of an electronic solution to improve malnutrition identification and support clinical best practice. J Hum Nutr Diet. 2022; 35: 1071–78. https://doi.org/10.1111/jhn.13026 10.1111/jhn.13026 PubMedWeb of Science®Google Scholar 5Maunder K, Marshall K, Syed K, Smilevska S, Beck E, Mak M, et al. Validation of an electronic food intake tool and its usability and efficacy in the healthcare setting. J Hum Nutr Diet. 2022; 35: 613–20. 10.1111/jhn.12969 PubMedWeb of Science®Google Scholar 6Shoneye CL, Kwasnicka D, Mullan B, Pollard CM, Boushey CJ, Kerr DA. Dietary assessment methods used in adult digital weight loss interventions: a systematic literature review. J Hum Nutr Diet. 2023. https://doi.org/10.1111/jhn.13101 10.1111/jhn.13101 Web of Science®Google Scholar 7Whatnall M, Clarke ED, Schumacher T, Rollo ME, Bucher T, et al. Do sauces, condiments and seasonings contribute important amounts of nutrients to Australian dietary intakes? J Hum Nutr Diet. 2023. https://doi.org/10.1111/jhn.13096 10.1111/jhn.13096 Web of Science®Google Scholar 8Ding Y, Yang Y, Li F, Shao Y, Sun Z, Zhong C, et al. Development and validation of a photographic atlas of food portions for accurate quantification of dietary intakes in China. J Hum Nutr Diet. 2021; 34: 604–15. 10.1111/jhn.12844 PubMedWeb of Science®Google Scholar 9Lucassen DA, Willemsen RF, Geelen A, Brouwer-Brolsma EM, Feskens EJM. The accuracy of portion size estimation using food images and textual descriptions of portion sizes: an evaluation study. J Hum Nutr Diet. 2021; 34: 945–52. 10.1111/jhn.12878 PubMedWeb of Science®Google Scholar 10McMahon NF, Brooker PG, Kadach S, Pavey TG, Leveritt MD. Estimating nitrate intake in the Australian diet: design and validation of a food frequency questionnaire. J Hum Nutr Diet. 2023; 36: 169–80. https://doi.org/10.1111/jhn.13048 10.1111/jhn.13048 PubMedWeb of Science®Google Scholar 11Rijnaarts I, de Roos N, Zoetendal EG, Wit N, Witteman BJM. Development and validation of the FiberScreen: a short questionnaire to screen fibre intake in adults. J Hum Nutr Diet. 2021; 34: 969–80. 10.1111/jhn.12941 PubMedWeb of Science®Google Scholar 12Graybeal AJ, Brandner CF, Tinsley GM. Validity and reliability of a mobile digital imaging analysis trained by a 4-compartment model. J Hum Nutr Diet. 2023. doi:10.1111/jhn.13113 Web of Science®Google Scholar 13Majmudar MD, Chandra S, Yakkala K, Kennedy S, Agrawal A, Sippel M, et al. Smartphone camera based assessment of adiposity: a validation study. NPJ Digit Med. 2022; 5:79. https://doi.org/10.1038/s41746-022-00628-3 10.1038/s41746-022-00628-3 PubMedWeb of Science®Google Scholar 14Martin CK, Nicklas T, Gunturk B, Correa JB, Allen HR, Champagne C. Measuring food intake with digital photography. J Hum Nutr Diet. 2014; 27: 72–81. 10.1111/jhn.12014 PubMedWeb of Science®Google Scholar 15Winzer E, Luger M, Schindler K. Using digital photography in a clinical setting: a valid, accurate and applicable method to assess food intake. Eur J Clin Nutr. 2018; 72: 879–87. 10.1038/s41430-018-0126-x PubMedWeb of Science®Google Scholar 16Titova J, Cottis G, Allman-Farinelli M. Using social media analysis to study population dietary behaviours: a scoping review. J Hum Nutr Diet. 2023. https://doi.org/10.1111/jhn.13077 10.1111/jhn.13077 Web of Science®Google Scholar 17Pearce J, Rundle R. Baby-led weaning: a thematic analysis of comments made by parents using online parenting forums. J Hum Nutr Diet. 2023. https://doi.org/10.1111/jhn.13078 10.1111/jhn.13078 Web of Science®Google Scholar Citing Literature Volume36, Issue3June 2023Pages 585-587 ReferencesRelatedInformation

The prevalence of overweight and obesity is rising in all parts of the world and, among young women, it presents a very clear danger during pregnancy. Women who are overweight or who gain excessive weight during pregnancy are at greater risk of complications in pregnancy and labour, and are more likely to lose their child to stillbirth or die themselves during pregnancy. This narrative review considers the evidence that, in addition to increasing risk of poor pregnancy outcomes, obesity has the capacity to programme foetuses to be at greater risk of cardiometabolic disorders later in life. An extensive body of evidence from prospective and retrospective cohorts, as well as record linkage studies, demonstrates associations of maternal obesity and/or gestational diabetes with cardiovascular disease, as well as type 1 and type 2 diabetes. Studies in animals suggest that these associations are underpinned by adaptations that occur in foetal life, which remodel the structures of major organs, including the brain, kidney and pancreas.

Vascular endothelial cells have a critical role in the maintenance of cardiovascular function. Evidence suggests that endothelial function may be compromised under conditions of magnesium deficiency, which increases vulnerability to inflammation. Whole genome transcription analysis was used to explore the acute (24 h) effects of magnesium on human umbilical vascular endothelial cells (HUVEC) cultured in low (0.1 mM) or high (5 mM) concentrations. With low magnesium 2728 transcripts were differentially expressed compared to the 1 mM control cultures and 3030 were differentially expressed with high magnesium. 615 transcripts were differentially expressed under both conditions, of which only 34 showed a concentration-dependent response. Analysis indicated that cellular organisation and biogenesis and key cellular processes such as apoptosis were impacted by both low and high conditions. High magnesium also influenced protein binding functions, intracellular signal transduction, metabolic and catalytic processes. Both conditions impacted on stress-related processes, in particular the inflammatory response. Key mediators of calcium-dependent regulation of gene expression were responsive to both high and low magnesium conditions. The HUVEC transcriptome is highly sensitive to acute changes in the concentration of magnesium in culture medium. The findings of this study support the view that whilst inflammation is an important process that is responsive to magnesium, the function of the endothelium may be impacted by other magnesium-induced changes including maintenance of cellular integrity, receptor expression and metabolic functions. The high proportion of transcripts that did not show a concentration-dependent response suggests variation in magnesium may elicit indirect changes, possibly mediated by other ions.

The introduction of solid foods and drinks other than milk (complementary feeding) is a key developmental milestone that exerts powerful changes in terms of functional changes to the gastrointestinal tract, the immune system and metabolic processes. Diversification of the diet exposes the infant to a greater range of fatty acids and proteins, and these, as well as associated micronutrients, must be absorbed from a more varied food matrix containing complex carbohydrates, and a following meal-based pattern of feeding. Successful complementary feeding must ensure that the requirements of the infant for nutrients are met by the dietary supply because milk is a poor source of iron, zinc, vitamin D and vitamin A, all of which are essential for the maintenance of normal growth and function. The introduction of solid foods also serves to stimulate the development of the reflexes that coordinate biting and chewing with swallowing of food. The World Health Organization has set out guidelines advising parents that all babies should be exclusively breastfed for the first 6 months of life, with no introduction of complementary foods prior to this time.1 At 6 months, nutritionally adequate complementary foods should be introduced, with continuation of breastfeeding to 2 years of age. The UK Department of Health generally advocates this approach, although their guidelines suggest flexibility by wording the advice as delay until “around 6 months.” It has been suggested that babies who can sit up and hold their head steady, have good hand-eye coordination, have lost the tongue thrust reflex and are growing at a rapid rate may benefit from introduction of solids at between 4 and 6 months. The timing of the introduction of complementary feeding is of considerable importance and so confusion among parents as a result of imprecise guidelines is unfortunate. Late introduction (after 6 months of age) puts infants at risk of malnutrition because their stores of nutrients that have carried over from fetal life will become depleted. Early introduction of solids carries a risk of choking, as well as a risk of overwhelming the capacity of the kidneys and gastrointestinal tract to handle solutes and nitrogenous waste (leading to dehydration), and also elevates the risk of gastroenteritis and allergic sensitisation. Preterm infants represent a special case and the introduction of complementary foods should be based upon their developmental stage rather than their chronological age. Early weaning is more likely in this group of infants and there may be ongoing consequences of doing so. A study of 108 preterm infants in Brazil found that use of inappropriate foods for weaning was also a problem and early introduction of ultra-processed foods, cows milk and wheat-based foods was associated with lower weight-for-age z-scores at age 2 years.2 The introduction of complementary foods should be accomplished gradually and the full process of weaning will typically take 6 months. Throughout that time, milk should remain a key part of the diet. Feeds of breast milk or appropriate infant formula should continue, with both later being used for drinks and mixing with solid foods. The World Health Organization strongly promotes breast milk and considers that commercial follow-on or growing-up milks are unnecessary.1 Importantly, formula milks targeted at infants older than 6 months of age are not regulated in the same way as milks for younger children. This enables open marketing and, globally, their use is increasing. Although such products are able to maintain intakes of iron and other micronutrients, when infants are transitioning to solid foods, they increase the risk of waterborne infection and exposure to contaminants, and also commit families to an unnecessary cost. Their use is growing particularly quickly in areas such as the Asia-Pacific region.3 The introduction of complementary foods is a process that generally involves parents selecting foods that have either been purchased specifically for use in the weaning process (commercially produced pureed foods) or household food items that have been pureed or finely chopped at home before being offered to babies via a spoon. Over time, the child will normally start to be offered unprocessed finger foods as the next step in the transition to normal family meals. The concern has been raised that this parentally driven process can pressure children to eat rather than to experiment with textures and flavours and hence develop their own food preferences. An alternative approach termed “baby-led weaning” is increasingly popular, particularly among families in high-income countries, including the UK. When the baby-led approach is adopted, infants are provided with finger foods from the initiation of weaning and self-select from the same foods that the rest of the family are consuming.4 It is claimed that this enables the development of the neural pathways that control satiety and enhances motor skills. It has been argued that freeing the infant from parental pressure to eat encourages self-regulation of appetite and will reduce risk of childhood obesity.5 In this issue of the Journal of Human Nutrition and Dietetics, two papers explore the impact of baby-led weaning on nutrient intake in infants. A study of 36 baby-led weaned infants compared to 60 traditionally weaned infants found that there were few differences between the groups of infants in terms of exposures to specific food groups,6 although nutrient intakes were different when infants were between 6 and 8 months of age. The infants in the baby-led group had lower intakes of micronutrients (iron, iodine, zinc, vitamin B12 and vitamin D) and milk provided a greater percentage of their daily energy and saturated fat intake.6 The smaller study by Brown et al.7 also found that baby-led weaning was associated with a greater proportion of energy and nutrients being delivered by breast or formula milk rather than from solid foods. This was consistent with the baby-led approach providing a slower transition to solids. Low intakes of micronutrients as reported in the current issue of the journal6, 7 have also been reported in previous studies and may be the product of infants self-selecting foods that are sweeter and less nutrient-dense.5, 8 The major concern expressed about baby-led weaning is that it may increase the risk of the infant choking because missing out the soft-food stage of the introduction of complementary food means that large food items may be encountered before the baby has full control over mastication. However, there is no compelling evidence that choking is a particular risk.9 There is some support for the idea that baby-led weaning facilitates self-regulation of food intake in infants,10 although the literature is fatally compromised by bias issues. Participants in studies of complementary feeding and the baby-led approach generally recruit well-educated, highly motivated, predominantly breastfeeding mother–baby pairs, with strong adherence to guidance on exclusive breastfeeding for 6 months. For example, Brown et al.7 reported that 80% of their sample were educated to at least degree level and, although 69% of “traditionally” weaning mothers were breastfeeding at 6 months, 88% were doing so in the baby-led group.7 Similarly, Pearce and Langley-Evans6 found that baby-led weaning mothers were more likely (86% baby led vs. 73% traditional weaning) to be breastfeeding beyond 6 months and were better educated than traditionally weaning women. To put this into context, only 75% of women in England and Wales (where these studies were conducted6, 7) even initiate breastfeeding and only 34% still breastfeed (only 1% exclusively) to 6 months. The clear sample bias issues in the literature make it difficult to dissect out any real effect of baby-led weaning from generally strong maternal health behaviours. Although not definitively demonstrated, the general balance of opinion is that longer-duration breastfeeding in itself protects infants from obesity.11 This confounds any association between baby-led weaning and childhood obesity5 and almost certainly other observations that baby-led weaning produces better growth or metabolic outcomes. The first year of life is unique in that there are no other life stages where there are such specific guidelines on food and nutrition. The World Health Organization has been very clear and directive in terms of breastfeeding advice and statements about when complementary foods should be introduced.1 Despite this specificity that is echoed by departments of health all over the world, compliance at the population level is remarkably poor and, in most parts of the world, solid foods are often introduced earlier than 6 months of age. It has been estimated that almost 20% of US infants receive solids before 4 months, whereas, in the UK, 75% of babies may start to be weaned by 5 months.12, 13 The reasons why guidance on complementary feeding is so poorly adhered to are complex in that decisions made by individual parents on how to proceed are shaped by many factors (socio-economic status, infant growth rate, maternal age, infant sleeping pattern), that are further modulated by local social and cultural norms. In the UK, a degree of confusion exists about the timing of weaning because the advice given to parents has been inconsistent. As a result, many parents mistrust the advice of health professionals,14 and prefer to make use of possibly unreliable sources to make judgements about timing and pattern of introduction of complementary foods. Many of those sources are now Internet-based and are subject to inaccuracy, deliberate misinformation15 and manipulation by manufacturers of formula milks and other products aimed at very young children. Confusion, lack of understanding and family/socio-cultural expectations drive parents to make decisions that they consider to be in the best interests of babies, but which do not sit well with the available evidence-base. Baby-led weaning may be one example of this. Cutting through the complex web of information and considering what may be effective drivers of appropriate weaning behaviour will require new approaches to engage parents and enhance compliance with feeding guidelines. Sangalli et al.16 have demonstrated how a primary care intervention that included training for mothers on the timing of complementary feeding and the types of food that should be used could be rolled out on a large scale in Brazil. Health centres in the intervention arm of the study gave women access to counselling on how to feed babies and children within Brazilian guidelines. At 3 years of age, children in the intervention arm had lower energy, carbohydrate and fat intakes than those in the control arm. At 6 years of age, the children in the intervention arm had smaller waist circumferences and skinfold measurements.16 This paper shows that that appropriate exposure to professional counselling can have a beneficial impact on the nutrition and growth of young children. It is clear that the answers to the current problems associated with complementary feeding in high- and middle-income countries do not lie in asking parents to let their babies to lead the way and select their own foods. It is noteworthy that almost 60% of parents who follow baby-led weaning use interactive media sources rather than health professionals to shape their approach to complementary feeding,17 which means that compliance with weaning guidelines is lower. Guidelines are already in place and have a strong evidence-base, such that the solutions lie in promoting the guidelines, enhancing access to reliable information, improving the training of health visitors so that they are better equipped to answer questions and promote behaviour change, and ensuring that parents of young children can access resources whenever they are required. Smartphone applications have been shown to be trusted and accessible to women in need of support when breastfeeding18 and perhaps similar eHealth solutions that follow on from breastfeeding promotion tools might prove beneficial in guiding parents through an infant's transition from milk to solid foods. High-quality resources are required to counteract the often poor and unreliable advice that parents extract from social media and Internet sources.

Background: Selenium deficiency is widespread in the Malawi population. The selenium concentration in maize, the staple food crop of Malawi, can be increased by applying selenium-enriched fertilizers. It is unknown whether this strategy, called agronomic biofortification, is effective at alleviating selenium deficiency.Objectives: The aim of the Addressing Hidden Hunger with Agronomy (AHHA) trial was to determine whether consumption of maize flour, agronomically-biofortified with selenium, affected the serum selenium concentrations of women, and children in a rural community setting.Design: An individually-randomized, double-blind placebo-controlled trial was conducted in rural Malawi. Participants were randomly allocated in a 1:1 ratio to receive either intervention maize flour biofortified with selenium through application of selenium fertilizer, or control maize flour not biofortified with selenium. Participant households received enough flour to meet the typical consumption of all household members (330 g capita−1 day−1) for a period of 8 weeks. Baseline and endline serum selenium concentration (the primary outcome) was measured by inductively coupled plasma mass spectrometry (ICP-MS).Results: One woman of reproductive age (WRA) and one school-aged child (SAC) from each of 180 households were recruited and households were randomized to each group. The baseline demographic and socioeconomic status of participants were well-balanced between arms. No serious adverse events were reported. In the intervention arm, mean (standard deviation) serum selenium concentration increased over the intervention period from 57.6 (17.0) μg L−1 (n = 88) to 107.9 (16.4) μg L−1 (n = 88) among WRA and from 46.4 (14.8) μg L−1 (n = 86) to 97.1 (16.0) μg L−1 (n = 88) among SAC. There was no evidence of change in serum selenium concentration in the control groups.Conclusion: Consumption of maize flour biofortified through application of selenium-enriched fertilizer increased selenium status in this community providing strong proof of principle that agronomic biofortification could be an effective approach to address selenium deficiency in Malawi and similar settings.Clinical Trial Registration:http://www.isrctn.com/ISRCTN85899451, identifier: ISRCTN85899451.

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre-pregnancy body mass index greater than 25 kg m(-2) are more likely than those with a body mass index in the ideal range (20-24.99 kg m(-2)) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

BACKGROUND:A baby-led approach to weaning (BLW) encompasses self-feeding and self-selecting graspable foods, offering an alternative to traditional weaning (TW). This cross-sectional study explored adherence to characteristics of BLW and differences in food group exposure and nutrient intake between babies following either TW or BLW.METHODS:Nutritional data were collected via multiple-pass 24-h recall, following parental completion of an online survey.RESULTS:Infants were grouped according to age (6-8 months; TW [n = 36] and BLW [n = 24]) and (9-12 months; TW [n = 24] and BLW [n = 12]). BLW babies were more likely to be breast fed (p = 0.002), consumed a higher percentage of foods also consumed by their mother (p = 0.008) and were fed less purees (p < 0.001) at 6-8 months. TW babies were spoon fed more (p ≤ 0.001) at all ages. Amongst babies aged 6-8 months, total intake (from complementary food plus milk) of iron (p = 0.021), zinc (p = 0.048), iodine (p = 0.031), vitamin B12 (p = 0.002) and vitamin D (p = 0.042) and both vitamin B12 (p = 0.027) and vitamin D (p = 0.035) from complementary food alone was higher in babies following TW. Compared to TW, BLW babies aged 6-8 months had a higher percentage energy intake from fat (p = 0.043) and saturated fat (p = 0.026) from their milk. No differences in nutrient intake were observed amongst infants aged 9-12 months. Few differences were observed between groups in their number of exposures to specific food groups.CONCLUSIONS:TW infants had higher intakes of key micronutrients at 6-8 months, although there were few differences in nutritional intake at 9-12 months or food group exposure between babies following TW or BLW. BLW appears to be socially desirable. Guidance for parents is required, along with larger, longer-term studies, which explore the potential impact of BLW in later childhood.

Journal of Human Nutrition and DieteticsVolume 35, Issue 3 p. 421-424 EDITORIAL Open research: Enhancing transparency in peer review Simon C. Langley-Evans, Corresponding Author Simon C. Langley-Evans simon.langley-evans@nottingham.ac.uk School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK Correspondence Simon C. Langley-Evans, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK. Email: simon.langley-evans@nottingham.ac.ukSearch for more papers by this author Simon C. Langley-Evans, Corresponding Author Simon C. Langley-Evans simon.langley-evans@nottingham.ac.uk School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK Correspondence Simon C. Langley-Evans, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK. Email: simon.langley-evans@nottingham.ac.ukSearch for more papers by this author First published: 16 May 2022 https://doi.org/10.1111/jhn.13007Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume35, Issue3June 2022Pages 421-424 RelatedInformation